NPIMap

Organization Active NPI

Central State Hospital

  • Psychiatric Hospital
  • Louisville, KY
National Provider Identifier
1366447609
Registry record updated Jul 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
100198 Issued in KY
Legal business name
CENTRAL STATE HOSPITAL
Practice address
10510 Lagrange Rd
Louisville, KY 40223-1277
Phone
(502) 253-7135
Fax
(502) 253-7044
NPI assigned
Jun 14, 2005
Organization subpart
Yes
Parent organization
COMMONWEALTH OF KENTUCKYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 30, 2010

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

Authorized official

Name
Mark L Reynolds
Title
Controller
Phone
(502) 253-7135

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 100198 KY Primary

Addresses

Primary practice location

10510 Lagrange Rd
Louisville, KY 40223-1277

Mailing address

10510 Lagrange Road
Louisville, KY 40223-1277

Other identifiers 1

IdentifierTypeStateIssuer
02021293MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080312000753 KY Part A Provider - Hospital 0840180816 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Louisville, KY

Hospital certification: CCN 184015

Legal name
COMMONWEALTH OF KENTUCKY
Doing business as
CENTRAL STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 30, 1987
Last certification
Jun 13, 2007
Beds
192
Ownership / control type
State
Organization structure
OtherNon-profit
Enrollment address
10510 La Grange Rd
Louisville, KY 40223-1277
Other Hospital Practice Location
Hospital subgroups
Psychiatric unit

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Central State HospitalCCN 184015
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Central State Hospital3 organizations share this tax ID, including this one
Part of
West Liberty Elementary

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Commonwealth of Kentucky Organization, Frankfort, KY 5% Or Greater Direct Ownership Interest Jun 1, 1992 100%
Matt Mooring Individual Corporate DirectorHospital Director Mar 7, 2019
Jennifer Moore Individual Operational/Managerial ControlAssistant Director May 1, 2015
Mathew Gayheart Individual Corporate DirectorDirector of Finance Jan 10, 2013
Katrice D Maddox Individual Operational/Managerial ControlBhdid Program Administrator Jun 1, 2015

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280448000000",
    "number": "1366447609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10510 LAGRANGE ROAD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402231277",
            "fax_number": "502-253-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10510 LAGRANGE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402231277",
            "telephone_number": "502-253-7135",
            "fax_number": "502-253-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL STATE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONWEALTH OF KENTUCKY",
        "enumeration_date": "2005-06-14",
        "last_updated": "2010-07-30",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "502-253-7135"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "KY",
            "license": "100198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02021293",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.