Provider Demographics
NPI:1588647895
Name:NORTH CENTRAL DISTRICT HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:NORTH CENTRAL DISTRICT HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DISTRICT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE'
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:502-845-2761
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:31 EAST CROSS MAIN STREET
Mailing Address - City:NEW CASTLE
Mailing Address - State:KY
Mailing Address - Zip Code:40050-0358
Mailing Address - Country:US
Mailing Address - Phone:502-845-2761
Mailing Address - Fax:502-845-7998
Practice Address - Street 1:30 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1020
Practice Address - Country:US
Practice Address - Phone:502-845-2761
Practice Address - Fax:502-845-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY150068251B00000X, 251E00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34002527Medicaid
KY34002527Medicaid