Provider Demographics
NPI:1194704999
Name:HENDERSON COUNTY HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:HENDERSON COUNTY HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-826-6436
Mailing Address - Street 1:851 KIMSEY LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2665
Mailing Address - Country:US
Mailing Address - Phone:270-826-6436
Mailing Address - Fax:270-826-7953
Practice Address - Street 1:851 KIMSEY LN
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2665
Practice Address - Country:US
Practice Address - Phone:270-826-6436
Practice Address - Fax:270-826-7953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100423313M00000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY750171OtherADULT DAY HEALTH CARE
KYD10725OtherSALES TAX USAGE NUMBER
KY12500591Medicaid
KY9000571100Medicaid
KY12500591Medicaid
KY750171OtherADULT DAY HEALTH CARE
KY4435360001Medicare NSC