Provider Demographics
NPI:1518030279
Name:HARRISON COUNTY HEALTH DEPARTMENT & HARRISON COUNTY HOME HEALTH
Entity Type:Organization
Organization Name:HARRISON COUNTY HEALTH DEPARTMENT & HARRISON COUNTY HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-425-6324
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-0425
Mailing Address - Country:US
Mailing Address - Phone:660-425-6324
Mailing Address - Fax:660-425-7642
Practice Address - Street 1:1700 BETHANY AVENUE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-0425
Practice Address - Country:US
Practice Address - Phone:660-425-6324
Practice Address - Fax:660-425-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511416000Medicaid
MO9004011Medicare ID - Type Unspecified