Provider Demographics
NPI:1548306079
Name:BULLITT COUNTY BOARD OF EDUCATION
Entity type:Organization
Organization Name:BULLITT COUNTY BOARD OF EDUCATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-543-2271
Mailing Address - Street 1:1040 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6122
Mailing Address - Country:US
Mailing Address - Phone:502-543-2271
Mailing Address - Fax:502-543-3608
Practice Address - Street 1:1040 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6122
Practice Address - Country:US
Practice Address - Phone:502-543-2271
Practice Address - Fax:502-543-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21015011Medicaid