1639515935 NPI number — HARLAN COUNTY HEALTH DEPARTMENT INC/ CAWOOD ELEMENTARY SCHOOL

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 1639515935 NPI number — HARLAN COUNTY HEALTH DEPARTMENT INC/ CAWOOD ELEMENTARY SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARLAN COUNTY HEALTH DEPARTMENT INC/ CAWOOD ELEMENTARY SCHOOL
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:
Provider Other Organization Name Type Code:
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:
1639515935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 E CLOVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLAN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40831-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-573-3700
Provider Business Mailing Address Fax Number:
606-573-6128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 NOLA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-3700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRIDER
Authorized Official First Name:
BOBBIE
Authorized Official Middle Name:
V
Authorized Official Title or Position:
INTERIM DIRECTOR
Authorized Official Telephone Number:
606-573-3700

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  3004105 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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