Healthcare Provider Details

I. General information

NPI: 1356754675
Provider Name (Legal Business Name): KNOX COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E ARC AVE
VINCENNES IN
47591-6888
US

IV. Provider business mailing address

2525 N 6TH ST
VINCENNES IN
47591-2405
US

V. Phone/Fax

Practice location:
  • Phone: 812-886-4312
  • Fax: 812-886-4844
Mailing address:
  • Phone: 812-886-4312
  • Fax: 812-886-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22003141A
License Number StateIN

VIII. Authorized Official

Name: JUDITH KOTTER
Title or Position: VP BUSINESS FINANCE
Credential:
Phone: 812-886-4312