Provider Demographics
NPI:1700950573
Name:HARRISON COUNTY HEALTH DEPARTMENT & HARRISON COUNTY HOME HEALTH
Entity Type:Organization
Organization Name:HARRISON COUNTY HEALTH DEPARTMENT & HARRISON COUNTY HOME HEALTH
Other - Org Name:HARRISON COUNTY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-425-8319
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-0425
Mailing Address - Country:US
Mailing Address - Phone:660-425-8319
Mailing Address - Fax:660-425-6939
Practice Address - Street 1:1700 BETHANY AVENUE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-0425
Practice Address - Country:US
Practice Address - Phone:660-425-8319
Practice Address - Fax:660-425-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO051-14HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO821416005Medicaid
MO91199012OtherBCBS PROVIDER NUMBER
MO91199012OtherBCBS PROVIDER NUMBER