Provider Demographics
NPI:1679986079
Name:MORRLAND HEALTHCARE
Entity type:Organization
Organization Name:MORRLAND HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-676-0638
Mailing Address - Street 1:401 BOGLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3823
Mailing Address - Country:US
Mailing Address - Phone:960-667-6063
Mailing Address - Fax:606-676-0789
Practice Address - Street 1:401 BOGLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3823
Practice Address - Country:US
Practice Address - Phone:960-667-6063
Practice Address - Fax:606-676-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100282540Medicaid