Provider Demographics
NPI:1164402061
Name:CLARK COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CLARK COUNTY HEALTH DEPARTMENT
Other - Org Name:CLARK COUNTY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KISSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-744-4482
Mailing Address - Street 1:400 PROFESSIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1147
Mailing Address - Country:US
Mailing Address - Phone:859-744-4482
Mailing Address - Fax:859-744-0338
Practice Address - Street 1:273 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2806
Practice Address - Country:US
Practice Address - Phone:859-744-1488
Practice Address - Fax:859-737-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
KY42001255251K00000X
KY45344264252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY42001255Medicaid
000000054785OtherANTHEM BC/BS
KY45344264Medicaid
787OtherTRI CARE
187083OtherUNICARE
787OtherOTHER INSURANCES
000000002666OtherCHA
KY34002253Medicaid
000000002666OtherCHA