Provider Demographics
NPI:1417071291
Name:CRITTENDEN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CRITTENDEN COUNTY HOSPITAL
Other - Org Name:MARION HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-965-1042
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KY
Mailing Address - Zip Code:42064-0386
Mailing Address - Country:US
Mailing Address - Phone:270-965-5281
Mailing Address - Fax:270-965-1061
Practice Address - Street 1:520 W GUM ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-0386
Practice Address - Country:US
Practice Address - Phone:270-965-5281
Practice Address - Fax:270-965-1061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRITTENDEN COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150144251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY42001289Medicaid
KY000000054475OtherANTHEM BLUE CROSS
KY34001289Medicaid
KY42001289Medicaid