Provider Demographics
NPI:1578639589
Name:LEWIS COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LEWIS COUNTY HEALTH DEPARTMENT
Other - Org Name:LEWIS COUNTY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-767-5312
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MO
Mailing Address - Zip Code:63457
Mailing Address - Country:US
Mailing Address - Phone:573-767-5312
Mailing Address - Fax:573-767-5301
Practice Address - Street 1:JUNCTION 16 & HWY A
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MO
Practice Address - Zip Code:63457
Practice Address - Country:US
Practice Address - Phone:573-767-5312
Practice Address - Fax:573-767-5301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS COUNTY HOME HEALTH AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20 22251E00000X
MO20-23HH251E00000X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO581816402Medicaid
MO511816407Medicaid
MO511816407Medicaid