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General NPI Number Information
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NPI Number | 1093967416
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Entity Type | Organization
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Legal Business Name | IT'S ABOUT TIME, INC
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 1316 S JEFFERSON ST
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City | ROANOKE
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State | VA
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Zip | 24016-4953
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Country | US
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Telephone | 540-206-2367
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Fax | 540-226-7640
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Provider Business Mailing Address
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Address Line | 1316 S JEFFERSON ST
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City | ROANOKE
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State | VA
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Zip | 24016-4953
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Country | US
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Telephone | 540-206-2367
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Fax | 540-226-7640
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | MS. MITZI JAYNE TUCK
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Credential | BSW QMRP
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Telephone | 540-206-2367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1113-02-006
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License Number State | VA
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