Provider Demographics
NPI:1326365677
Name:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Name:HORSE BRANCH ELEMENTARY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:270-686-7747
Mailing Address - Street 1:1501 BRECKENRIDGE ST
Mailing Address - Street 2:PO BOX 309
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1054
Mailing Address - Country:US
Mailing Address - Phone:270-686-7747
Mailing Address - Fax:270-926-9862
Practice Address - Street 1:11980 US HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:HORSE BRANCH
Practice Address - State:KY
Practice Address - Zip Code:42349-9540
Practice Address - Country:US
Practice Address - Phone:270-274-4662
Practice Address - Fax:270-274-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid