Provider Demographics
NPI:1851449243
Name:MARSHALL COUNTY HOSPITAL AND LONG TERM CARE FACILITY
Entity Type:Organization
Organization Name:MARSHALL COUNTY HOSPITAL AND LONG TERM CARE FACILITY
Other - Org Name:MARSHALL COUNTY HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-527-8084
Mailing Address - Street 1:501 GEORGE MCCLAIN DR
Mailing Address - Street 2:PO BOX 630
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1365
Mailing Address - Country:US
Mailing Address - Phone:270-527-8084
Mailing Address - Fax:270-527-9474
Practice Address - Street 1:501 GEORGE MCCLAIN DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1365
Practice Address - Country:US
Practice Address - Phone:270-527-8084
Practice Address - Fax:270-527-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150168251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY187161Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER NUMB