Healthcare Provider Details

I. General information

NPI: 1922182815
Provider Name (Legal Business Name): KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 GORMAN HOLLOW RD
HAZARD KY
41701-2315
US

IV. Provider business mailing address

441 GORMAN HOLLOW RD
HAZARD KY
41701-2315
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2361
  • Fax: 606-439-0870
Mailing address:
  • Phone: 606-439-2361
  • Fax: 606-439-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number150043
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150043
License Number StateKY

VIII. Authorized Official

Name: MR. ANTHONY SCOTT LOCKARD
Title or Position: PUBLIC HEALTH DIRECTOR
Credential: MSW, CSW
Phone: 606-439-2361