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General NPI Number Information
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NPI Number | 1225338502
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Entity Type | Organization
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Legal Business Name | KATHLEEN ANDERSON COMPREHENSIVE WORK CENTER INC
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1095 BELLE AVE
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City | CASSELBERRY
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State | FL
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Zip | 32708-2961
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Country | US
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Telephone | 407-699-4419
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Fax | 407-699-7967
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Provider Business Mailing Address
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Address Line | 1095 BELLE AVE
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City | CASSELBERRY
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State | FL
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Zip | 32708-2961
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Country | US
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Telephone | 407-699-4419
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Fax | 407-699-7967
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WILLIAM HARRY POE
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Credential |
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Telephone | 407-699-4419
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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 | 002
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License Number State | FL
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