Healthcare Provider Details

I. General information

NPI: 1164402061
Provider Name (Legal Business Name): CLARK COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 SHOPPERS DR
WINCHESTER KY
40391-2806
US

IV. Provider business mailing address

400 PROFESSIONAL AVE
WINCHESTER KY
40391-1147
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-1488
  • Fax: 859-737-2618
Mailing address:
  • Phone: 859-744-4482
  • Fax: 859-744-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number42001255
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number45344264
License Number StateKY

VIII. Authorized Official

Name: REBECCA A KISSICK
Title or Position: DIRECTOR
Credential:
Phone: 859-744-4482