Provider Demographics
NPI:1225039555
Name:PULASKI COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PULASKI COUNTY HEALTH DEPARTMENT
Other - Org Name:PULASKI COUNTY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-736-2217
Mailing Address - Street 1:101 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CROCKER
Mailing Address - State:MO
Mailing Address - Zip Code:65452-9203
Mailing Address - Country:US
Mailing Address - Phone:573-736-2219
Mailing Address - Fax:573-736-5847
Practice Address - Street 1:101 12TH ST
Practice Address - Street 2:
Practice Address - City:CROCKER
Practice Address - State:MO
Practice Address - Zip Code:65452-9203
Practice Address - Country:US
Practice Address - Phone:573-736-2219
Practice Address - Fax:573-736-5847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULASKI COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-09
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO61-20251E00000X
MO00011371251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580563005Medicaid
MO267057Medicare ID - Type Unspecified
MO267057Medicare Oscar/Certification