Healthcare Provider Details

I. General information

NPI: 1649274606
Provider Name (Legal Business Name): HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 MILLER ST
BETHANY MO
64424-2704
US

IV. Provider business mailing address

2600 MILLER ST
BETHANY MO
64424-2701
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-7863
  • Fax: 660-425-8026
Mailing address:
  • Phone: 660-425-2211
  • Fax: 660-425-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA GILLESPIE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 660-425-2211