Healthcare Provider Details

I. General information

NPI: 1730222795
Provider Name (Legal Business Name): CUMBERLAND VALLEY DIST. HEALTH DEPT.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 HWY 219
WALLINS KY
40873
US

IV. Provider business mailing address

PO BOX 158
MANCHESTER KY
40962-0158
US

V. Phone/Fax

Practice location:
  • Phone: 606-664-7722
  • Fax:
Mailing address:
  • Phone: 606-598-5564
  • Fax: 606-598-6615

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: HERMAN JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 606-598-5564