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General NPI Number Information
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NPI Number | 1104063254
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Entity Type | Organization
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Legal Business Name | MPOWERING KIDS MENTORING LLC
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 34 E MAIN ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-2720
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Country | US
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Telephone | 276-618-0759
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Fax | 276-638-2680
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Provider Business Mailing Address
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Address Line | PO BOX 3229 34 E. MAIN STREET
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City | MARTINSVILLE
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State | VA
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Zip | 24115-3229
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Country | US
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Telephone | 276-634-0060
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Fax | 276-632-2280
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Authorized Official
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Title or Position | CEO
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Name | VICKIE ADAMS
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Credential |
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Telephone | 276-618-0759
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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