Provider Demographics
NPI:1366642829
Name:THREE RIVERS DISTRICT HEALTH CARE
Entity Type:Organization
Organization Name:THREE RIVERS DISTRICT HEALTH CARE
Other - Org Name:MAURICE BOWLING MIDDLE SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Practice Address - Street 1:2380 HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-9176
Practice Address - Country:US
Practice Address - Phone:502-484-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1366642829Medicaid