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NPI Code Detail

MEDICARE: HENDERSON COUNTY HEALTH CARE CORPORATION

MEDICARE: HENDERSON COUNTY HEALTH CARE CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility100423KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1750171OTHERKYADULT DAY HEALTH CARE
2D10725OTHERKYSALES TAX USAGE NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194704999
Entity Type Code : Organization
Provider Name (Legal Business Name) : HENDERSON COUNTY HEALTH CARE CORPORATION
Provider Business Mailing Address
First Line : 851 KIMSEY LN
Second Line :
City : HENDERSON
State : KY
Zip : 42420-2665
Country : US
Telephone Number : 270-826-6436
Fax Number : 270-826-7953
Provider Business Practice Location Address
First Line : 851 KIMSEY LN
Second Line :
City : HENDERSON
State : KY
Zip : 42420-2665
Country : US
Telephone Number : 270-826-6436
Fax Number : 270-826-7953
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. MARK CHUMBLER
Credential :
Telephone Number : 270-826-6436
Provider Enumeration Date : 01/11/2006
Last Update Date : 01/28/2014

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1881840858 — MRS. LAUREN NICHOLE BALL COTA/L
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Directions to “HENDERSON COUNTY HEALTH CARE CORPORATION ” Practice Location

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