Provider Demographics
NPI:1689717639
Name:CUMBERLAND VALLEY DIST. HEALTH DEPT.
Entity Type:Organization
Organization Name:CUMBERLAND VALLEY DIST. HEALTH DEPT.
Other - Org Name:HARLAN CO.-GREENHILLS ELEM.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-5564
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-0158
Mailing Address - Country:US
Mailing Address - Phone:606-598-5564
Mailing Address - Fax:606-598-6615
Practice Address - Street 1:123 WEST HWY. 221
Practice Address - Street 2:
Practice Address - City:BLEDSOE
Practice Address - State:KY
Practice Address - Zip Code:40810
Practice Address - Country:US
Practice Address - Phone:606-558-3195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFLU0210Medicare ID - Type Unspecified