Provider Demographics
NPI:1407043979
Name:KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC.
Entity type:Organization
Organization Name:KENTUCKY MOUNTAIN HEALTH ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-487-9505
Mailing Address - Street 1:279 E MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1920
Mailing Address - Country:US
Mailing Address - Phone:606-487-9505
Mailing Address - Fax:606-436-0071
Practice Address - Street 1:279 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1920
Practice Address - Country:US
Practice Address - Phone:606-487-9505
Practice Address - Fax:606-436-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)