Provider Demographics
NPI:1407803315
Name:MARY BRECKENRIDGE HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:MARY BRECKENRIDGE HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILLA
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:606-672-2355
Mailing Address - Street 1:166 KATE IRELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749
Mailing Address - Country:US
Mailing Address - Phone:606-672-2355
Mailing Address - Fax:
Practice Address - Street 1:166 KATE IRELAND DRIVE
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749
Practice Address - Country:US
Practice Address - Phone:606-672-2355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150022251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY42000166Medicaid
KY34000273Medicaid
KY187001Medicare ID - Type UnspecifiedHOME HEALTH CARE