Healthcare Provider Details

I. General information

NPI: 1982762514
Provider Name (Legal Business Name): CUMBERLAND VALLEY DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 MANCHESTER SQUARE SHPG CTR SUITE 200
MANCHESTER KY
40962-8781
US

IV. Provider business mailing address

PO BOX 190 470 MANCHESTER SQUARE SUITE 200
MANCHESTER KY
40962-8781
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-5564
  • Fax: 606-598-6615
Mailing address:
  • Phone: 606-598-5564
  • Fax: 606-598-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number150042
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number150042
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number150042
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150042
License Number StateKY

VIII. Authorized Official

Name: MS. GLENNA HENSLEY
Title or Position: HOME HEALTH MANAGER
Credential:
Phone: 606-598-5564