Breathitt County Health Department
Organization Active NPI Home Health Agency · Jackson, KY
NPI 1295809291 · NPPES record last updated Aug 15, 2024
Key facts
- NPI
- 1295809291
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 150004 (KY)
- Legal business name
- BREATHITT COUNTY HEALTH DEPARTMENT
- Practice address
- 955 Highway 30 West
Jackson, KY 41339-0730 - Phone
- (606) 666-8052
- Fax
- (606) 666-4601
- NPI assigned
- Nov 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Elizabeth Miller
- Title
- Director
- Phone
- (606) 666-7755
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 3
-
Stephan N Trent, DO
Affiliated clinicians 1
-
Amy Fowler, D.O
Medicare Care Compare: Home health agency
- Listed as
- Breathitt County HHA
- Overall star rating
- ★★★☆☆ 2.5 of 5
- Ownership
- Government Operated
- Certified
- Feb 14, 1969
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Home health agency certification: CCN 187023
- Legal name
- BREATHITT COUNTY HEALTH DEPARTMENT
- Doing business as
- BREATHITT COUNTY HOME HEALTH AGENCY
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 14, 1969
- Last certification
- Apr 11, 2018
- Ownership / control type
- Government Operated
- Organization structure
- Other · Non-profit
- Enrollment address
- 955 Highway 30 W
Jackson, KY 41339-7846
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Lorene Campbell |
W-2 Managing Employee | Nov 4, 2011 | |
| Angela Raleigh |
Corporate Director | Feb 13, 2017 | |
| Breathitt County Health Department |
5% Or Greater Indirect Ownership Interest | Nov 4, 2011 | |
| Operational/Managerial Control | Nov 4, 2011 | ||
| Belita Noble |
W-2 Managing Employee | Feb 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120104000874 | KY | Part a Provider - Home Health Agency | 4880657956 | Practice locations: Jackson, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | 150004 | KY | |
| Home Health Agency | 251E00000X | 150004 | KY | Yes |
Addresses
Primary practice location
955 Highway 30 West
Jackson, KY 41339-0730
Mailing address
PO Box 730
Jackson, KY 41339-0730
Phone (606) 666-8052
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42000075 | Other | KY | WAIVER |
| 34001131 | Medicaid | KY |
Other names
- Breathitt County Home Health
Other providers in Jackson, KY
- Braden Partners LP
- Angela Shawn Bradley
- Breathit County Imaging Center
- Breathitt County Ambulance, Inc.
- Breathitt County Board of Education
- Breathitt County Health Department
- Breathitt County Home Medical LLC
- Breathitt Dental Clinic PSC
- Breathitt Emergency Group, LLC
- Breathitt-Wolfe EMS Inc
All providers in Jackson, KY · Home Health Agency in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.