Provider Demographics
NPI:1558519769
Name:ALLEN COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ALLEN COUNTY HEALTH DEPARTMENT
Other - Org Name:ALLEN COUNTY INTERMEDIATE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-237-4423
Mailing Address - Street 1:107 N COURT ST
Mailing Address - Street 2:P.O. BOX 129
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1429
Mailing Address - Country:US
Mailing Address - Phone:270-237-4423
Mailing Address - Fax:270-237-4777
Practice Address - Street 1:720 OLIVER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-8818
Practice Address - Country:US
Practice Address - Phone:270-618-8200
Practice Address - Fax:270-618-8205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEN COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-29
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100066140Medicaid