Provider Demographics
NPI:1356561468
Name:PIKE COUNTY HEALTH DEPARTMENT, HOME CARE AND HOSPICE
Entity type:Organization
Organization Name:PIKE COUNTY HEALTH DEPARTMENT, HOME CARE AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-324-2111
Mailing Address - Street 1:19 N MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-1643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 N MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-1643
Practice Address - Country:US
Practice Address - Phone:573-324-2111
Practice Address - Fax:573-324-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO281646703Medicaid
MO261646707Medicaid