Healthcare Provider Details

I. General information

NPI: 1548304868
Provider Name (Legal Business Name): LAKE CUMBERLAND DISTRICT HEALTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E LAKESHORE DR
BURNSIDE KY
42519-9454
US

IV. Provider business mailing address

500 BOURNE AVE
SOMERSET KY
42501-1916
US

V. Phone/Fax

Practice location:
  • Phone: 606-561-4250
  • Fax: 606-561-4562
Mailing address:
  • Phone: 606-678-4761
  • Fax: 606-676-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier20100053
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name: MR. SHAWN D. CRABTREE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 606-678-4761