Provider Demographics
NPI:1922101815
Name:WOLFE COUNTY HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:WOLFE COUNTY HEALTH CARE CENTER, INC.
Other - Org Name:WOLFE COUNTY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:FORCHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-528-9600
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-0370
Mailing Address - Country:US
Mailing Address - Phone:606-668-3216
Mailing Address - Fax:606-668-3220
Practice Address - Street 1:838 KY HWY 191
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301
Practice Address - Country:US
Practice Address - Phone:606-668-3216
Practice Address - Fax:606-668-3220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CORBIN LONG TERM CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100636314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
610038100OtherFEDERAL BLACK LUNG
KY000000054870OtherANTHEM BCBS
KY12500013Medicaid
KY12500013Medicaid