Provider Demographics
NPI:1235113713
Name:WHITLEY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:WHITLEY COUNTY HEALTH DEPARTMENT
Other - Org Name:WHITLEY COUNTY HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:TIMPERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-549-3380
Mailing Address - Street 1:368 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-7481
Mailing Address - Country:US
Mailing Address - Phone:606-549-0886
Mailing Address - Fax:606-549-2665
Practice Address - Street 1:368 PENNY LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-7481
Practice Address - Country:US
Practice Address - Phone:606-549-0886
Practice Address - Fax:606-549-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150034251E00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY42011189OtherMEDICAID WAIVER
KY45345881OtherEPSDT
KY34011189Medicaid
KY34011189Medicaid