Provider Demographics
NPI:1063409266
Name:GREEN RIVER DISTRICT HEALTH DEPT
Entity type:Organization
Organization Name:GREEN RIVER DISTRICT HEALTH DEPT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD, CDE
Authorized Official - Phone:270-686-7747
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0309
Mailing Address - Country:US
Mailing Address - Phone:270-686-8123
Mailing Address - Fax:270-683-1119
Practice Address - Street 1:1600 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1055
Practice Address - Country:US
Practice Address - Phone:270-686-8123
Practice Address - Fax:270-683-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150007252Y00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3400251900Medicaid
KY3400251900Medicaid