Provider Demographics
NPI:1154099281
Name:GREEN RIVER REGIONAL MENTAL HEALTH/MENTAL RETARDATION BOARD, INC.
Entity Type:Organization
Organization Name:GREEN RIVER REGIONAL MENTAL HEALTH/MENTAL RETARDATION BOARD, INC.
Other - Org Name:AMETHYST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-689-6540
Mailing Address - Street 1:1100 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-2956
Mailing Address - Country:US
Mailing Address - Phone:270-689-6642
Mailing Address - Fax:270-689-6677
Practice Address - Street 1:1224 VENABLE AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2756
Practice Address - Country:US
Practice Address - Phone:270-689-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility