Presbyterian Homes and Services of Kentucky, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100516 Issued in KY

Legal business name

PRESBYTERIAN HOMES AND SERVICES OF KENTUCKY, INC

Doing business as

Good Shepherd Community Nursing Center
Good Shepherd Health

Practice address

60 Phillips Branch Rd
Phelps, KY 41553-9061

Phone

(502) 259-9101

Fax

(502) 259-9109

NPI assigned

Sep 29, 2005

Last updated

Jun 16, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hattie Wagner

Title

Ceo/President

Phone

(502) 259-9101

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Good Shepherd Community Nursing Center Doing business as
• Good Shepherd Health Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1104813880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18067",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402610067",
            "telephone_number": "502-259-9101",
            "fax_number": "502-259-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 PHILLIPS BRANCH RD",
            "city": "PHELPS",
            "state": "KY",
            "postal_code": "415539061",
            "telephone_number": "502-259-9101",
            "fax_number": "502-259-9109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOMES AND SERVICES OF KENTUCKY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "HATTIE",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "502-259-9101"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KY",
            "license": "100516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12504080",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Community Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Shepherd Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mansoor Mahmood
• Robert Sean McGuirk, OTR/L
• Rina Dawn McNutt, COTA/L
• One Call Medical and Telehealth
• Phelps Ky Opco LLC (Good Shepherd Health and Rehabilitation)
• Lee Ingal Restar, P.T.
• James Donith Sanders X, M.S., CCC/SLP
• Sound Mind Counseling, LLC
• Danielle Marie Sperow, COTA
• Henrietta Lynn Sullivan

• Skilled Nursing Facility in Phelps, KY
• Providers in Phelps, KY by specialty
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.