1578757928 NPI number — KENTUCKY RIVER DISTRICT HEALTH DEPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578757928 NPI number — KENTUCKY RIVER DISTRICT HEALTH DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY RIVER DISTRICT HEALTH DEPT
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:
COWAN HEADSTART
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:
1578757928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 GORMAN HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41701-2315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-439-2361
Provider Business Mailing Address Fax Number:
606-439-0870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 931 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITESBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-633-0718
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DISTRICT DIRECTOR
Authorized Official Telephone Number:
606-439-2361

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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