Provider Demographics
NPI:1841216934
Name:WESTERN KY REGIONAL MHMR BOARD INC
Entity Type:Organization
Organization Name:WESTERN KY REGIONAL MHMR BOARD INC
Other - Org Name:FOUR RIVERS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDSPETH
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:270-442-1452
Mailing Address - Street 1:425 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001
Mailing Address - Country:US
Mailing Address - Phone:270-442-7121
Mailing Address - Fax:270-443-9692
Practice Address - Street 1:425 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-442-7121
Practice Address - Fax:270-443-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800001261QM0801X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000057108OtherANTHEM BCBS
KY27001015Medicaid
KY30601017Medicaid
KY29100946Medicaid
KY33900242Medicaid
KY28001014Medicaid
KY29100948Medicaid
000000057108OtherANTHEM BCBS
KY29100948Medicaid