Provider Demographics
NPI:1831173103
Name:BOYLE COUNTY HEALTH DEPT
Entity type:Organization
Organization Name:BOYLE COUNTY HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBILC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:859-236-2053
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0398
Mailing Address - Country:US
Mailing Address - Phone:859-236-2053
Mailing Address - Fax:859-236-2863
Practice Address - Street 1:448 SOUTH 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-2053
Practice Address - Fax:859-236-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20011011Medicaid
KY20011011Medicaid