Provider Demographics
NPI:1205833043
Name:MADISON COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MADISON COUNTY HEALTH DEPARTMENT
Other - Org Name:MEPCO HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:859-626-4501
Mailing Address - Street 1:216 BOGGS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2522
Mailing Address - Country:US
Mailing Address - Phone:859-623-3441
Mailing Address - Fax:859-626-4283
Practice Address - Street 1:216 BOGGS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2522
Practice Address - Country:US
Practice Address - Phone:859-623-3441
Practice Address - Fax:859-626-4283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WH0200X
KY150057251E00000X
KY150067252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34002766Medicaid
KY45344132Medicaid
KY34002766Medicaid