COMMONWEALTH OF KENTUCKY (NPI# 1033197967) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033197967 |
| Entity Type | Organization |
| Organization Name | COMMONWEALTH OF KENTUCKY |
| Other Organization Name | HAZELWOOD CENTER |
| Practice Address |
1800 Bluegrass Ave Louisville KY 40215-1130 |
| Practice Telephone | 5023612301 |
| Practice Fax Number | 5023636114 |
| Mailing Telephone | 5023612301 |
| Mailing Fax Number | 5023636114 |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2014-05-06 |
| Authorized Official Name | WENDY MORRIS (DEPUTY COMMISSIONER) |
| Authorized Official Telephone | 5025644527 |
| Is Organization Subpart | Y |
| Parent Organization Name | COMMONWEALTH OF KENTUCKY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 100211 | KY | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 11906070 | 05 |
| Other Name | Type Code |
|---|---|
| Hazelwood Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043686900 | Commonwealth of Kentucky | Skilled Nursing Facility | 100 Veterans Drive, Radcliff, KY 40160 | 2015-08-14 |
| 1245657857 | Commonwealth of Kentucky | Clinic/Center | 2441 Us Highway 27, Somerset, KY 42501 | 2014-03-20 |
| 1730329897 | Commonwealth of Kentucky | Intermediate Care Facility, Mentally Retarded | 400 Eastwood, 2441 S. Hwy 27, Somerset, KY 42501 | 2009-03-03 |
| 1588804546 | Commonwealth of Kentucky | Intermediate Care Facility, Mentally Retarded | 400 Eastwood Dr, 2441 S. Hwy 27, Somersetq, KY 42501 | 2009-03-03 |
| 1770762833 | Commonwealth of Kentucky | Residential Treatment Facility, Physical Disabilities | 5659 Main St, Thelma, KY 41260-8609 | 2007-10-25 |
| 1396962551 | Commonwealth of Kentucky | Nursing Facility/Intermediate Care Facility | 200 Veterans Dr, Hazard, KY 41701-9484 | 2007-04-19 |
| 1124144456 | Commonwealth of Kentucky | Pharmacy | 2400 Russellville Road, Hopkinsville, KY 42240 | 2007-03-21 |
| 1194862599 | Commonwealth of Kentucky | Intermediate Care Facility, Mentally Retarded | 23524 Dawson Springs Rd, Dawson Springs, KY 42408-9205 | 2007-02-01 |
| 1083785125 | Commonwealth of Kentucky | Intermediate Care Facility, Mentally Retarded | 4401-4505 Louise Underwood Way, Louisville, KY 40216 | 2006-11-12 |
| 1689652513 | Commonwealth of Kentucky | Intermediate Care Facility, Mentally Retarded | 210 Meadows Dr, Mt Washington, KY 40047-6013 | 2005-12-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COMMONWEALTH OF KENTUCKY - DEPARTMENT FOR LOCAL GOVERNMENT | 1024 Capital Center Dr Ste 340, Frankfort, KY 40601-7514 |
| Street Address |
1800 BLUEGRASS AVE |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40215-1130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982608543 | Lawrence G. Goldberg | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2005-06-10 |
| 1902376817 | Emily Kristen Mcwilliams | Physical Therapy Assistant | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2018-12-04 |
| 1174093090 | Ethan Cole Adams | Physical Therapist | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2018-12-04 |
| 1902376825 | Jennifer Weiger | Occupational Therapy Assistant | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2018-12-04 |
| 1720558646 | Travis Petty | Physical Therapy Assistant | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2018-12-04 |
| 1467928895 | Lydia Coots | Physical Therapist | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2018-10-24 |
| 1366937260 | Hayley Russell | Nurse Practitioner | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2018-06-25 |
| 1508358359 | Ashley Newton | Nurse Practitioner | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2018-06-06 |
| 1316458987 | Lydia Coughlin | Speech-Language Pathologist | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2017-10-23 |
| 1073062634 | Ashley Nicole Hill | Speech-Language Pathologist | 1800 Bluegrass Ave, Louisville, KY 40215-1130 | 2016-09-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417473315 | Robin Jones | Behavioral Analyst | 800 W. Woodlawn Ave, Louisville, KY 40215 | 2017-08-22 |
| 1316332448 | Christopher Fenzel | Emergency Medicine | 1850 Bluegrass Avenue, Louisville, KY 40215 | 2015-04-06 |
| 1447661210 | Khac Phuong Vu | Dentist | 3448 Taylor Boulevard, Louisville, KY 40215 | 2014-05-15 |
| 1619251238 | Scott H Kaminsky | Marriage & Family Therapist | 3535 Taylor Blvd, Louisville, KY 40215 | 2011-09-30 |
| 1821313529 | Taylor Blvd Chiropractic | Chiropractor | 3254 Taylor Blvd, Louisville, KY 40215 | 2010-04-06 |
| 1396985131 | Jewish Hospital & St. Mary's Healthcare, Inc. | Psychiatric Residential Treatment Facility | 4419 Lasalle Ave, Louisville, KY 40215 | 2009-03-05 |
| 1841448735 | Jewish Hospital & St. Mary's Healthcare, Inc. | Psychiatric Residential Treatment Facility | 4418 Malcolm Ave., Louisville, KY 40215 | 2008-09-04 |
| 1235329400 | Thad R. Schulten Psc | Dentist | 4515 Churchman Ave., Louisville, KY 40215 | 2007-07-25 |
| 1801911680 | Timothy John Lutes | Dentist | 3205 Taylor Blvd, Louisville, KY 40215 | 2007-03-20 |
| 1063557346 | Louisville-jefferson County Metro Government | Public Health or Welfare | 4255 Hazelwood Avenue, Louisville, KY 40215 | 2007-02-21 |
| Find all providers in zip 40215 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306017439 | The Academy for Individual Excellence, Inc. | Intermediate Care Facility, Mentally Retarded | 3101 Bluebird Ln, Louisville, KY 40299-3803 | 2008-03-17 |
| 1538356712 | Voca Corporation of Ohio | Intermediate Care Facility, Mentally Retarded | 4230 Lesh St, Louisville, OH 44641-8605 | 2007-10-01 |
| 1083785125 | Commonwealth of Kentucky | Intermediate Care Facility, Mentally Retarded | 4401-4505 Louise Underwood Way, Louisville, KY 40216 | 2006-11-12 |
| 1598721383 | Petersen Health Quality, LLC | Intermediate Care Facility, Mentally Retarded | 52 Old Rte 45, Louisville, IL 62858-0116 | 2006-04-21 |
| 1043298979 | Commonwealth of Kentucky | Intermediate Care Facility, Mentally Retarded | 5512 Del Maria Way, Louisville, KY 40291-1810 | 2005-12-30 |
| 1316241961 | Southern Home Care Services, Inc. | Intermediate Care Facility, Mentally Retarded | 9901 Linn Station Rd, Louisville, KY 40223-3808 | 2010-12-22 |
| 1275836124 | Southern Home Care Services, Inc. | Intermediate Care Facility, Mentally Retarded | 9901 Linn Station Rd, Louisville, KY 40223-3808 | 2010-12-15 |
| 1922233469 | Rscr California, Inc. | Intermediate Care Facility, Mentally Retarded | 9901 Linn Station Rd, Louisville, KY 40223-3808 | 2009-05-28 |
| 1467624288 | Voca Corporation of Florida | Intermediate Care Facility, Mentally Retarded | 9901 Linn Station Rd, Louisville, KY 40223-3808 | 2008-04-01 |
| 1700057833 | Alternative Youth Services, Inc. | Intermediate Care Facility, Mentally Retarded | 200 High Rise Dr, Suite 155, Louisville, KY 40213-3252 | 2008-03-17 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40215 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.