Provider Demographics
NPI:1265490601
Name:JOHNSON COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:JOHNSON COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DALETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:606-789-2596
Mailing Address - Street 1:630 JAMES TRIMBLE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240
Mailing Address - Country:US
Mailing Address - Phone:606-789-2596
Mailing Address - Fax:606-789-3244
Practice Address - Street 1:630 JAMES TRIMBLE BLVD
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240
Practice Address - Country:US
Practice Address - Phone:606-789-2596
Practice Address - Fax:606-789-3244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSON COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY150046251C00000X, 251S00000X
KY150046251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY42005819OtherHCBW
KY45344140OtherEPSDT
KY1265490601OtherNPI
KY34002584Medicaid
KY45344140OtherEPSDT