Provider Demographics
NPI:1770689432
Name:PINEVILLE COMMUNITY HOSPITAL ASSOCIATION INC.
Entity type:Organization
Organization Name:PINEVILLE COMMUNITY HOSPITAL ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:606-337-7205
Mailing Address - Street 1:850 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1430
Mailing Address - Country:US
Mailing Address - Phone:606-337-7205
Mailing Address - Fax:606-337-7898
Practice Address - Street 1:121 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1600
Practice Address - Country:US
Practice Address - Phone:606-337-7205
Practice Address - Fax:606-337-7898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINEVILLE COMMUNITY HOSPITAL ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-16
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34002071Medicaid
KY34002071Medicaid