Provider Demographics
NPI:1386790343
Name:THE CHILDREN'S ADVOCACY CENTER OF GREEN RIVER DISTRICT
Entity type:Organization
Organization Name:THE CHILDREN'S ADVOCACY CENTER OF GREEN RIVER DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEVINCY
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, CSW
Authorized Official - Phone:270-830-8400
Mailing Address - Street 1:537 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3902
Mailing Address - Country:US
Mailing Address - Phone:270-830-8400
Mailing Address - Fax:270-830-8262
Practice Address - Street 1:537 S GREEN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3902
Practice Address - Country:US
Practice Address - Phone:270-830-8400
Practice Address - Fax:270-830-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY13000153Medicaid