Provider Demographics
NPI:1982898243
Name:CUMBERLAND VALLEY DIST. HEALTH DEPT.
Entity Type:Organization
Organization Name:CUMBERLAND VALLEY DIST. HEALTH DEPT.
Other - Org Name:HARLAN CO.-BLACK MTN. ELEM.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-5564
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:MANCHESTER SQUARE SHOPPING CTR. ROOM 212
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-0158
Mailing Address - Country:US
Mailing Address - Phone:606-598-5564
Mailing Address - Fax:606-598-6615
Practice Address - Street 1:1555 HWY 215
Practice Address - Street 2:
Practice Address - City:KENVIR
Practice Address - State:KY
Practice Address - Zip Code:40847
Practice Address - Country:US
Practice Address - Phone:606-837-2214
Practice Address - Fax:606-573-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100002600Medicaid