1356383236 NPI number — GREEN RIVER REGIONAL MENTAL HEALTH/MENTAL RETARDATION BOARD, INC.

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 1356383236 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:
Provider Other Organization Name Type Code:
6
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:
1356383236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO 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:
42302-1637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-691-0786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 RUDY RD
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:
42301-9562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-691-0786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOUNTAIN
Authorized Official First Name:
J.
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
270-689-6500

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  950012 , 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)





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