Healthcare Provider Details

I. General information

NPI: 1407803315
Provider Name (Legal Business Name): MARY BRECKENRIDGE HOME HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 KATE IRELAND DRIVE
HYDEN KY
41749
US

IV. Provider business mailing address

166 KATE IRELAND DRIVE
HYDEN KY
41749
US

V. Phone/Fax

Practice location:
  • Phone: 606-672-2355
  • Fax:
Mailing address:
  • Phone: 606-672-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150022
License Number StateKY

VIII. Authorized Official

Name: MRS. WILLA DEAN MORRIS
Title or Position: DIRECTOR OF HOME HEALTH
Credential: REGISTERED NURSE
Phone: 606-672-2355