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General NPI Number Information
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NPI Number | 1265462097
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Entity Type | Organization
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Legal Business Name | PARC WORKSHOP, INC.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 674 JOHNSON ST
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City | STUART
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State | VA
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Zip | 24171-4001
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Country | US
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Telephone | 276-694-4211
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Fax | 276-694-2916
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Provider Business Mailing Address
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Address Line | 674 JOHNSON ST
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City | STUART
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State | VA
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Zip | 24171-4001
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Country | US
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Telephone | 276-694-4211
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Fax | 276-694-2916
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. HENRY GALE AYERS
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Credential |
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Telephone | 276-694-4211
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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 | 60602006
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License Number State | VA
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