Provider Demographics
NPI:1922182815
Name:KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:KENTUCKY RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSW
Authorized Official - Phone:606-439-2361
Mailing Address - Street 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-439-0870
Practice Address - Street 1:441 GORMAN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2315
Practice Address - Country:US
Practice Address - Phone:606-439-2361
Practice Address - Fax:606-439-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150043251C00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45349008Medicaid
KY34004978Medicaid
KY34004978Medicaid