Provider Demographics
NPI:1891446563
Name:OWEN ESSENTIAL CARE, PLC
Entity Type:Organization
Organization Name:OWEN ESSENTIAL CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-514-5972
Mailing Address - Street 1:1640 MUSSEL SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-9458
Mailing Address - Country:US
Mailing Address - Phone:502-514-5972
Mailing Address - Fax:
Practice Address - Street 1:1525 HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-8053
Practice Address - Country:US
Practice Address - Phone:502-514-5972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100052760Medicaid