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General NPI Number Information
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NPI Number | 1366091738
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Entity Type | Organization
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Legal Business Name | GREEN RIVER AREA DOWN SYNDROME
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 7155 MASONVILLE HABIT RD
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City | PHILPOT
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State | KY
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Zip | 42366-9116
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Country | US
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Telephone | 479-223-1234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2031
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City | OWENSBORO
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State | KY
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Zip | 42302-2031
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Country | US
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Telephone | 270-681-5313
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TIFFANY THRASH
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Credential |
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Telephone | 479-223-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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