Provider Demographics
NPI:1659595304
Name:ROCKCASTLE COUNTY ADULT HEALTH CARE
Entity Type:Organization
Organization Name:ROCKCASTLE COUNTY ADULT HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:606-256-4316
Mailing Address - Street 1:1260 S. WILDERNESS RD
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456
Mailing Address - Country:US
Mailing Address - Phone:606-256-4316
Mailing Address - Fax:606-256-1626
Practice Address - Street 1:1260 S. WILDERNESS ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456
Practice Address - Country:US
Practice Address - Phone:606-256-4316
Practice Address - Fax:606-256-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750080261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43001023Medicaid