Provider Demographics
NPI:1407997331
Name:THE PENNYRILE CHILDREN'S ADVOCACY CENTER
Entity Type:Organization
Organization Name:THE PENNYRILE CHILDREN'S ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:270-881-1111
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0014
Mailing Address - Country:US
Mailing Address - Phone:270-881-1111
Mailing Address - Fax:270-881-1105
Practice Address - Street 1:409 E 7TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3438
Practice Address - Country:US
Practice Address - Phone:270-881-1111
Practice Address - Fax:270-881-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare