1902082852 NPI number — WESTERN KY REGIONA MHMR BOARD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902082852 NPI number — WESTERN KY REGIONA MHMR BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN KY REGIONA MHMR BOARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FOUR RIVERS BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902082852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 BROADWAY ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42001-0713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-442-7121
Provider Business Mailing Address Fax Number:
270-443-9692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42001-0713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-7121
Provider Business Practice Location Address Fax Number:
270-443-9692
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OGDEN
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
270-442-7121

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  810061 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28001014 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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