Provider Demographics
NPI:1386851533
Name:KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Name:LEATHERWOOD ELEMENTARY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-439-2361
Mailing Address - Street 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-439-0870
Practice Address - Street 1:7777 KY HIGHWAY 699
Practice Address - Street 2:
Practice Address - City:LEATHERWOOD
Practice Address - State:KY
Practice Address - Zip Code:41731-9013
Practice Address - Country:US
Practice Address - Phone:606-675-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100000270Medicaid