Provider Demographics
NPI:1104874858
Name:LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC., CAH
Entity type:Organization
Organization Name:LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC., CAH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-988-2299
Mailing Address - Street 1:131 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-8043
Mailing Address - Country:US
Mailing Address - Phone:270-988-2299
Mailing Address - Fax:270-988-3900
Practice Address - Street 1:205 E ADAIR STREET
Practice Address - Street 2:
Practice Address - City:SMITHLAND
Practice Address - State:KY
Practice Address - Zip Code:42081
Practice Address - Country:US
Practice Address - Phone:270-928-2146
Practice Address - Fax:270-928-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600071261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65944019Medicaid
KY65944019Medicaid
KY9744Medicare ID - Type Unspecified