1760539902 NPI number — PENNYRILE AREA DEVELOPMENT DISTRICT

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 1760539902 NPI number — PENNYRILE AREA DEVELOPMENT DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNYRILE AREA DEVELOPMENT DISTRICT
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:
1760539902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HAMMOND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42240-7952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-886-9484
Provider Business Mailing Address Fax Number:
270-886-3211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HAMMOND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-7952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-886-9484
Provider Business Practice Location Address Fax Number:
270-886-3211
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOZARTH
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
270-886-9484

Provider Taxonomy Codes

  • Taxonomy code: 251X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 43996024 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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