Provider Demographics
NPI:1255372686
Name:OUR LADY OF BELLEFONTE HOSPITAL INC
Entity type:Organization
Organization Name:OUR LADY OF BELLEFONTE HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-627-5573
Mailing Address - Street 1:700 SAINT CHRISTOPHER DR
Mailing Address - Street 2:MEDICAL BUILDING III, SUITE 105
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7062
Mailing Address - Country:US
Mailing Address - Phone:606-833-3545
Mailing Address - Fax:606-833-3546
Practice Address - Street 1:700 SAINT CHRISTOPHER DR
Practice Address - Street 2:MEDICAL BUILDING III, SUITE 105
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7062
Practice Address - Country:US
Practice Address - Phone:606-833-3545
Practice Address - Fax:606-833-3546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR LADY OF BELLEFONTE HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150098251S00000X, 261QR0400X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY450000155Medicaid
KY0000000OtherANTHEM REHAB
KY000000054555OtherANTHEM
OH0586843Medicaid
KY34000026Medicaid
KY42000000Medicaid
KY0000000OtherANTHEM REHAB