| Commonwealth Of Kentucky | |
|
10510 Lagrange Road Louisville KY 40223 | |
| (502) 253-7000 | |
| (503) 253-7044 |
| Full Name | Commonwealth Of Kentucky |
|---|---|
| Speciality | Psychiatric Hospital |
| Location | 10510 Lagrange Road, Louisville, Kentucky |
| Authorized Official Name and Position | Jennifer Moore (ASSISTANT DIRECTOR) |
| Authorized Official Contact | 5027826117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Commonwealth Of Kentucky 10510 Lagrange Road Louisville KY 40223 Ph: (502) 253-7000 | Commonwealth Of Kentucky 10510 Lagrange Road Louisville KY 40223 Ph: (502) 253-7000 |
| NPI Number | 1578871679 |
|---|---|
| Provider Enumeration Date | 09/23/2010 |
| Last Update Date | 10/30/2024 |
| Medicare PECOS PAC ID | 0840180816 |
|---|---|
| Medicare Enrollment ID | O20080312000753 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578871679 | NPI | - | NPPES |
| 02021293 | Medicaid | KY |
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