OrganizationActive
District 4 Cdo Program
NPI 1164559522 · Supports Brokerage Agency · Bowling Green, KY
Provider details
- NPI number
- 1164559522
- Entity type
- Organization
- Primary specialty
- Supports Brokerage AgencyAgencies
- Authorized official
- Ronald Becker, Acting Executive Director
Practice location
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
Registry dates
- Enumerated
- 2007-02-27
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.