Provider Demographics
NPI:1154748986
Name:ACK HEALTHCARE MANAGEMENT, LLC
Entity type:Organization
Organization Name:ACK HEALTHCARE MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-489-0862
Mailing Address - Street 1:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1099
Mailing Address - Country:US
Mailing Address - Phone:502-277-5170
Mailing Address - Fax:502-277-5172
Practice Address - Street 1:1520 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351
Practice Address - Country:US
Practice Address - Phone:270-295-3890
Practice Address - Fax:270-295-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100295770Medicaid
KY18D2054463OtherCLIA
KYK131610Medicare PIN