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General NPI Number Information
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NPI Number | 1063872547
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Entity Type | Organization
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Legal Business Name | LORI KNAPP RICHLAND INC AS FISCAL AGENT
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 106 S BEAUMONT RD
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City | PRAIRIE DU CHIEN
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State | WI
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Zip | 53821-1449
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Country | US
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Telephone | 608-326-0434
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Fax |
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Provider Business Mailing Address
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Address Line | 106 S BEAUMONT RD
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City | PRAIRIE DU CHIEN
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State | WI
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Zip | 53821
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Country | US
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Telephone | 608-326-0434
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Fax |
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Authorized Official
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Title or Position | KNAPPS DEVELOPMENT INC PRESIDENT
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Name | MR. TONY WEDGEWORTH
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Credential |
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Telephone | 608-326-0434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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