Provider Demographics
NPI:1609042142
Name:LAUREL COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LAUREL COUNTY HEALTH DEPARTMENT
Other - Org Name:LONDON ELEMENTARY SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-878-7754
Mailing Address - Street 1:525 WHITLEY ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2626
Mailing Address - Country:US
Mailing Address - Phone:606-878-7754
Mailing Address - Fax:606-864-8295
Practice Address - Street 1:525 WHITLEY ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2626
Practice Address - Country:US
Practice Address - Phone:606-878-7754
Practice Address - Fax:606-864-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QP0905X261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20000303Medicaid