Healthcare Provider Details

I. General information

NPI: 1275008930
Provider Name (Legal Business Name): BARREN RIVER AREA DEVELOPMENT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 GRAHAM AVE
BOWLING GREEN KY
42101-9175
US

IV. Provider business mailing address

177 GRAHAM AVE
BOWLING GREEN KY
42101-9175
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-2381
  • Fax: 270-842-0768
Mailing address:
  • Phone: 270-781-2381
  • Fax: 270-842-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIC SEXTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 270-781-2381