Healthcare Provider Details

I. General information

NPI: 1265614507
Provider Name (Legal Business Name): LITTLE SANDY DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WARRIOR DR
OLIVE HILL KY
41164-0098
US

IV. Provider business mailing address

PO BOX 909
GRAYSON KY
41143-0909
US

V. Phone/Fax

Practice location:
  • Phone: 606-286-2524
  • Fax: 606-286-8556
Mailing address:
  • Phone: 606-474-6685
  • Fax: 606-474-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. PAULA L THORNBERRY
Title or Position: ACCOUNT CLERK
Credential:
Phone: 606-474-6685