District 4 Cdo Program

Primary specialty

Supports Brokerage AgencyTaxonomy code 251X00000X

Legal business name

DISTRICT 4 CDO PROGRAM

Practice address

177 Graham Ave
Bowling Green, KY 42101-9175

Phone

(270) 781-2381

Fax

(270) 842-0768

NPI assigned

Feb 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald Gene Becker

Title

Interim Executive Director

Phone

(270) 781-2381

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BARREN RIVER AREA AGENCY ON AGING Other name

Tax ID family

Barren River Area Agency on Aging3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• District 4 Cdo Program

  • Supports Brokerage Agency
  • Bowling Green, KY
  • NPI 1164559522
  NPD tax ID
• District 4 Cdo Program

  • Supports Brokerage Agency
  • Bowling Green, KY
  • NPI 1588702294
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255468617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 90005",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421029005",
            "telephone_number": "270-781-2381",
            "fax_number": "270-842-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 GRAHAM AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421019175",
            "telephone_number": "270-781-2381",
            "fax_number": "270-842-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTRICT 4 CDO PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "INTERIM EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "270-781-2381"
    },
    "taxonomies": [
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4399604000",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BARREN RIVER AREA AGENCY ON AGING",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kaitlyn Elaine Dickinson, LPCC
• Dignity Living LLP
• Abby N Dill, LCSW
• Megan Dimaoala, RBT
• District 4 Cdo Program
• District 4 Cdo Program
• Andrea Ditmore, RBT
• Dixie Infusion Clinic, LLC
• Jobeth Dixon
• Carl W Dobson, MD

• Supports Brokerage Agency in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Supports Brokerage Agency in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.