| Organization Name: | PENNYROYAL MENTAL HEALTH MH/MR BOARD |
| NPI Number: | 1053624197 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIC EMBRY (CFO) |
| Mailing Address: | 607 Hammond Plz Hopkinsville |
| State: | KY US |
| Postal Code: | 422404971 |
| Phone Number: | 2708862205 |
| Fax Number: | 2708860392 |
| NPI Enumeration Date: | 07/19/2010 |
| NPI Last Update Date: | 07/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 1036760 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |