Provider Demographics
NPI:1295809291
Name:BREATHITT COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:BREATHITT COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
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:606-666-8052
Mailing Address - Fax:606-666-4601
Practice Address - Street 1:955 HIGHWAY 30 WEST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-0730
Practice Address - Country:US
Practice Address - Phone:606-666-8052
Practice Address - Fax:606-666-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150004251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY42000075OtherWAIVER
KY34001131Medicaid
KY34001131Medicaid