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General NPI Number Information
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NPI Number | 1003033085
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Entity Type | Organization
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Legal Business Name | GREEN RIVER AREA DEVELOPMENT DISTRICT
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 300 GRADD WAY
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City | OWENSBORO
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State | KY
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Zip | 42301-8696
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Country | US
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Telephone | 270-926-4433
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Fax | 270-684-0714
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Provider Business Mailing Address
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Address Line | 300 GRADD WAY
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City | OWENSBORO
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State | KY
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Zip | 42301-8696
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Country | US
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Telephone | 270-926-4433
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Fax | 270-684-0714
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JITEN SHAH
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Credential |
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Telephone | 270-926-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State | KY
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