Provider Demographics
NPI:1982762514
Name:CUMBERLAND VALLEY DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CUMBERLAND VALLEY DISTRICT HEALTH DEPARTMENT
Other - Org Name:CUMBERLAND VALLEY DISTRICT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME HEALTH MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-5564
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:470 MANCHESTER SQUARE SUITE 200
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-8781
Mailing Address - Country:US
Mailing Address - Phone:606-598-5564
Mailing Address - Fax:606-598-6615
Practice Address - Street 1:470 MANCHESTER SQUARE SHPG CTR
Practice Address - Street 2:SUITE 200
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-8781
Practice Address - Country:US
Practice Address - Phone:606-598-5564
Practice Address - Fax:606-598-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150042251B00000X, 251E00000X, 251J00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41055013OtherMODEL WAIVER
KY42001263OtherKENTUCKY MEDICAID WAIVER
KY45343696OtherEPSDT
KY34002261Medicaid
KY42001263OtherKENTUCKY MEDICAID WAIVER