=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225286081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORI KNAPP RICHLAND, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2008
-----------------------------------------------------
Last Update Date | 09/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1140 SEXTONVILLE ROAD #5
-----------------------------------------------------
City | RICHLAND CENTER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-647-5247
-----------------------------------------------------
Fax | 608-647-5918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1140 SEXTONVILLE ROAD #5
-----------------------------------------------------
City | RICHLAND CENTER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-647-5247
-----------------------------------------------------
Fax | 608-647-5918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DONALD B KNAPP JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-326-5536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------