Provider Demographics
NPI:1770637969
Name:BREATHITT COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BREATHITT COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LD
Authorized Official - Phone:606-666-7755
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0730
Mailing Address - Country:US
Mailing Address - Phone:606-666-7755
Mailing Address - Fax:
Practice Address - Street 1:955 HWY. 30 WEST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-1000
Practice Address - Country:US
Practice Address - Phone:606-666-7755
Practice Address - Fax:606-666-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY15001068Medicaid
KY20013017Medicaid
KY15001068Medicaid