Provider Demographics
NPI:1548201379
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:RIVERVALLEY BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-689-6500
Mailing Address - Street 1:1000 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-8715
Mailing Address - Country:US
Mailing Address - Phone:270-689-6800
Mailing Address - Fax:
Practice Address - Street 1:1000 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-8715
Practice Address - Country:US
Practice Address - Phone:270-689-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100586283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY02021251Medicaid