NPI 1164559522

District 4 Cdo Program

Organisation Supports Brokerage Agency Bowling Green, KY

Practice location

Address: 177 Graham Ave, Bowling Green, KY 42101-9175
Phone: (270) 781-2381
Fax: (270) 842-0768
Mailing address: PO Box 90005, Bowling Green, KY 42102-9005

Authorised official

Name: Ronald Gene Becker
Title: Acting Executive Director
Phone: (270) 781-2381

Registered specialties

Supports Brokerage Agency Primary

Agencies Taxonomy 251X00000X

Other Supports Brokerage providers in Kentucky →

Registry record

NPI: 1164559522
Entity type: Organization
NPI issued: 27 Feb 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.