1164402061 NPI number — CLARK COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1164402061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164402061 NPI number — CLARK COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARK COUNTY HEALTH DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLARK COUNTY HOME HEALTH AGENCY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164402061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 PROFESSIONAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40391-1147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-744-4482
Provider Business Mailing Address Fax Number:
859-744-0338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
273 SHOPPERS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40391-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-744-1488
Provider Business Practice Location Address Fax Number:
859-737-2618
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KISSICK
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
859-744-4482

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251K00000X , with the licence number: 42001255 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 45344264 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42001255 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054785 . This is a "ANTHEM BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45344264 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 787 . This is a "TRI CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 187083 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 787 . This is a "OTHER INSURANCES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000002666 . This is a "CHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34002253 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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