Healthcare Provider Details

I. General information

NPI: 1437296167
Provider Name (Legal Business Name): PENNYRILE AREA DEVELOPMENT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HAMMOND DR
HOPKINSVILLE KY
42240-7952
US

IV. Provider business mailing address

300 HAMMOND DR
HOPKINSVILLE KY
42240-7952
US

V. Phone/Fax

Practice location:
  • Phone: 270-886-9484
  • Fax:
Mailing address:
  • Phone: 270-886-9484
  • Fax:

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: DAN BOZARTH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 270-886-9484