Provider Demographics
NPI:1558493270
Name:GREEN RIVER DISTRICT HOME HEALTH
Entity Type:Organization
Organization Name:GREEN RIVER DISTRICT HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-686-7747
Mailing Address - Street 1:1600 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1055
Mailing Address - Country:US
Mailing Address - Phone:270-686-8123
Mailing Address - Fax:270-683-1119
Practice Address - Street 1:1501 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1054
Practice Address - Country:US
Practice Address - Phone:270-686-8123
Practice Address - Fax:270-683-1119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45344884Medicaid