Provider Demographics
NPI:1952522054
Name:PIKE COUNTY HEALTH DEPT HOME HEALTH
Entity Type:Organization
Organization Name:PIKE COUNTY HEALTH DEPT HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
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 1:1 HEALTH CARE PLACE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334
Mailing Address - Country:US
Mailing Address - Phone:573-324-2111
Mailing Address - Fax:573-324-3057
Practice Address - Street 1:1 HEALTH CARE PLACE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334
Practice Address - Country:US
Practice Address - Phone:573-324-2111
Practice Address - Fax:573-324-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO511646705Medicaid