Provider Demographics
NPI:1073572905
Name:THREE RIVERS DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:THREE RIVERS DISTRICT HEALTH DEPARTMENT
Other - Org Name:PENDLETON COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:502-484-3412
Mailing Address - Street 1:60 OLD MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-9030
Mailing Address - Country:US
Mailing Address - Phone:502-484-3412
Mailing Address - Fax:502-484-0864
Practice Address - Street 1:329 HWY 330 W
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040
Practice Address - Country:US
Practice Address - Phone:859-654-6985
Practice Address - Fax:859-654-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20096012Medicaid
KY20096012Medicaid