Provider Demographics
NPI:1184258998
Name:CLARK COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CLARK COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSICK HAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-744-4482
Mailing Address - Street 1:400 PROFESSIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1147
Mailing Address - Country:US
Mailing Address - Phone:859-744-4482
Mailing Address - Fax:859-744-0338
Practice Address - Street 1:400 PROFESSIONAL AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1147
Practice Address - Country:US
Practice Address - Phone:859-744-4482
Practice Address - Fax:859-744-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency