Provider Demographics
NPI:1598983090
Name:PURCHASE DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PURCHASE DISTRICT HEALTH DEPARTMENT
Other - Org Name:EPSDT
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-9625
Mailing Address - Street 1:916 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-1955
Mailing Address - Country:US
Mailing Address - Phone:270-444-9625
Mailing Address - Fax:
Practice Address - Street 1:916 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-1955
Practice Address - Country:US
Practice Address - Phone:270-444-9625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45344074Medicaid