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General NPI Number Information
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NPI Number | 1205287323
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Entity Type | Organization
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Legal Business Name | ARCHER INTERVENTIONS
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 06/30/2016
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Provider Practice Location Address
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Address Line | 109 E FOREST AVE
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City | HODGENVILLE
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State | KY
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Zip | 42748-1303
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Country | US
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Telephone | 270-735-5715
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Fax | 270-358-0963
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Provider Business Mailing Address
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Address Line | 109 E FOREST AVE
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City | HODGENVILLE
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State | KY
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Zip | 42748-1303
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Country | US
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Telephone | 270-735-5715
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Fax | 270-358-0963
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRITT MARIE SHERRARD
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Credential | DI
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Telephone | 270-735-5715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 201126597
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License Number State | KY
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