Provider Demographics
NPI:1023009354
Name:AUDRAIN COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:AUDRAIN COUNTY HEALTH CENTER
Other - Org Name:AUDRAIN COUNTY HEALTH DEPARTMENT HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIRPERSON
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-581-1332
Mailing Address - Street 1:1130 S ELMWOOD
Mailing Address - Street 2:P.O. BOX 957
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-0957
Mailing Address - Country:US
Mailing Address - Phone:573-581-1332
Mailing Address - Fax:573-581-6652
Practice Address - Street 1:1130 S ELMWOOD
Practice Address - Street 2:BOX 957
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-0957
Practice Address - Country:US
Practice Address - Phone:573-581-1332
Practice Address - Fax:573-581-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO739-2251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580563906Medicaid
MO580563906Medicaid