Provider Demographics
NPI:1366091738
Name:GREEN RIVER AREA DOWN SYNDROME
Entity type:Organization
Organization Name:GREEN RIVER AREA DOWN SYNDROME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:THRASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-223-1234
Mailing Address - Street 1:PO BOX 2031
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-2031
Mailing Address - Country:US
Mailing Address - Phone:270-681-5313
Mailing Address - Fax:
Practice Address - Street 1:7155 MASONVILLE HABIT RD
Practice Address - Street 2:
Practice Address - City:PHILPOT
Practice Address - State:KY
Practice Address - Zip Code:42366-9116
Practice Address - Country:US
Practice Address - Phone:479-223-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities