Provider Demographics
NPI:1649274606
Name:HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-425-2211
Mailing Address - Street 1:2600 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2701
Mailing Address - Country:US
Mailing Address - Phone:660-425-2211
Mailing Address - Fax:660-425-8026
Practice Address - Street 1:2703 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2704
Practice Address - Country:US
Practice Address - Phone:660-425-7863
Practice Address - Fax:660-425-8026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-08
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO285125308Medicaid
MO265125302Medicaid
MO584726004Medicaid
MO854726007Medicaid
MO854726007Medicaid
MO90936011OtherBCBS