Provider Demographics
NPI:1679502272
Name:THREE RIVERS DISTRICT HEALTH DEPT
Entity Type:Organization
Organization Name:THREE RIVERS DISTRICT HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:502-484-3412
Mailing Address - Street 1:60 OLD MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-9030
Mailing Address - Country:US
Mailing Address - Phone:502-484-3412
Mailing Address - Fax:502-484-0864
Practice Address - Street 1:60 OLD MONTEREY RD
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-9030
Practice Address - Country:US
Practice Address - Phone:502-484-3412
Practice Address - Fax:502-484-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 251E00000X
KY150069376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
Yes251K00000XAgenciesPublic Health or Welfare
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45345451Medicaid
KY34001941Medicaid
KY45345451Medicaid
KY42001941OtherMEDICAID WAIVER