Provider Demographics
NPI:1518144070
Name:BARREN RIVER DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BARREN RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Name:SUMMER SHADE ELEMENTARY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-781-8039
Mailing Address - Street 1:1109 STATE ST
Mailing Address - Street 2:P O BOX 1157
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2648
Mailing Address - Country:US
Mailing Address - Phone:270-781-2490
Mailing Address - Fax:270-796-8946
Practice Address - Street 1:235 NOBOB SUMMER SHADE RD
Practice Address - Street 2:
Practice Address - City:SUMMER SHADE
Practice Address - State:KY
Practice Address - Zip Code:42166-9412
Practice Address - Country:US
Practice Address - Phone:270-428-3962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100025350Medicaid