Provider Demographics
NPI:1952506008
Name:UNITED HEALTCARE OF HARDIN
Entity Type:Organization
Organization Name:UNITED HEALTCARE OF HARDIN
Other - Org Name:LINCOLN TRAIL BEHAVIORAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:270-351-9444
Mailing Address - Street 1:3909 S WILSON RD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-8944
Mailing Address - Country:US
Mailing Address - Phone:270-351-9444
Mailing Address - Fax:270-351-0400
Practice Address - Street 1:3909 S WILSON RD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-8944
Practice Address - Country:US
Practice Address - Phone:270-351-9444
Practice Address - Fax:270-351-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100574283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45016151OtherEPSDT NUMBER