Healthcare Provider Details

I. General information

NPI: 1063409266
Provider Name (Legal Business Name): GREEN RIVER DISTRICT HEALTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BRECKENRIDGE ST
OWENSBORO KY
42303-1055
US

IV. Provider business mailing address

PO BOX 309
OWENSBORO KY
42302-0309
US

V. Phone/Fax

Practice location:
  • Phone: 270-686-8123
  • Fax: 270-683-1119
Mailing address:
  • Phone: 270-686-8123
  • Fax: 270-683-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150007
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number150007
License Number StateKY

VIII. Authorized Official

Name: MRS. DEBORAH FILLMAN
Title or Position: PUBLIC HEALTH DIRECTOR
Credential: MS, RD, LD, CDE
Phone: 270-686-7747