Provider Demographics
NPI:1396017521
Name:HAZARD PERRY COUNTY COMMUNITY MINISTRIES, INC.
Entity Type:Organization
Organization Name:HAZARD PERRY COUNTY COMMUNITY MINISTRIES, INC.
Other - Org Name:COMMUNITY MINISTRIES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:D.W.
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:606-439-1122
Mailing Address - Street 1:151 MISS EDNA LN
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1530
Mailing Address - Country:US
Mailing Address - Phone:606-439-1122
Mailing Address - Fax:606-439-1160
Practice Address - Street 1:151 MISS EDNA LN
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1530
Practice Address - Country:US
Practice Address - Phone:606-439-1122
Practice Address - Fax:606-439-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health