Provider Demographics
NPI:1356313498
Name:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Other - Org Name:HENDERSON COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-686-7747
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0309
Mailing Address - Country:US
Mailing Address - Phone:270-686-7747
Mailing Address - Fax:270-926-9862
Practice Address - Street 1:472 KLUTEY PARK PLAZA
Practice Address - Street 2:HENDERSON COUNTY HEALTH CENTER
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420
Practice Address - Country:US
Practice Address - Phone:270-826-3951
Practice Address - Fax:270-826-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20051017Medicaid
KY20051017Medicaid