Provider Demographics
NPI:1073650644
Name:PENNYRILE AREA DEVELPOMENT DISTRICT
Entity Type:Organization
Organization Name:PENNYRILE AREA DEVELPOMENT DISTRICT
Other - Org Name:PENNYRILE AREA AGENCY ON AGING
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZARTH
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43996024OtherHCBW