Provider Demographics
NPI:1437113156
Name:PURCHASE DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PURCHASE DISTRICT HEALTH DEPARTMENT
Other - Org Name:PURCHASE DISTRICT HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-9625
Mailing Address - Street 1:PO BOX 2357
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002
Mailing Address - Country:US
Mailing Address - Phone:270-444-9625
Mailing Address - Fax:270-575-5458
Practice Address - Street 1:916 KENTUCKY AVE
Practice Address - Street 2:MCCRACKEN COUNTY HOME HEALTH AGENCY
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-1955
Practice Address - Country:US
Practice Address - Phone:270-444-9631
Practice Address - Fax:270-444-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150024251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4200173500Medicaid
KY3400273300Medicaid
KY4534407400Medicaid
KY4107301600Medicaid
KY4200173500Medicaid