Provider Demographics
NPI:1689082315
Name:GRAVES COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GRAVES COUNTY HEALTH DEPARTMENT
Other - Org Name:SOUTH LIVINGSTON CO ELEMENTARY-MUSTANG
Other - Org Type:Other Name
Authorized Official - Title/Position:SSSA III
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-247-3553
Mailing Address - Street 1:416 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-3115
Mailing Address - Country:US
Mailing Address - Phone:270-247-3553
Mailing Address - Fax:270-247-0391
Practice Address - Street 1:850 CUTOFF RD
Practice Address - Street 2:
Practice Address - City:SMITHLAND
Practice Address - State:KY
Practice Address - Zip Code:42081-8914
Practice Address - Country:US
Practice Address - Phone:270-247-3553
Practice Address - Fax:270-247-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare