Provider Demographics
NPI:1003284084
Name:PENNYRILE AREA DEVELOPMENT DISTRICT
Entity Type:Organization
Organization Name:PENNYRILE AREA DEVELOPMENT DISTRICT
Other - Org Name:VETERANS DIRECTED CARE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-886-9484
Mailing Address - Street 1:300 HAMMOND DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-7952
Mailing Address - Country:US
Mailing Address - Phone:270-886-9484
Mailing Address - Fax:270-886-3211
Practice Address - Street 1:300 HAMMOND DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-7952
Practice Address - Country:US
Practice Address - Phone:270-886-9484
Practice Address - Fax:270-886-3211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENNYRILE AREA DEVELOPMENT DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1073650644Medicaid
KY1437296167Medicaid
KY1982741559Medicaid