1285689711 NPI number — GREEN RIVER REGIONAL MENTAL HEALTH/MENTAL RETARDATION BOARD, INC.

Table of content: (NPI 1285689711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285689711 NPI number — GREEN RIVER REGIONAL MENTAL HEALTH/MENTAL RETARDATION BOARD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN RIVER REGIONAL MENTAL HEALTH/MENTAL RETARDATION BOARD, INC.
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:
RIVERVALLEY 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:
1285689711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-689-6500
Provider Business Mailing Address Fax Number:
270-689-6677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-689-6500
Provider Business Practice Location Address Fax Number:
270-689-6500
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HICKS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
270-689-6540

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 800003 , 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: 29202033 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17010307 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27003011 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29102035 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33900093 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29003010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30603013 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com