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General NPI Number Information
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NPI Number | 1285002964
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Entity Type | Organization
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Legal Business Name | FRIENDS OF CANAAN INCORPORATED
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 8775 N CANAAN MAIN ST
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City | MADISON
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State | IN
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Zip | 47250-8489
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Country | US
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Telephone | 812-839-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 8775 N CANAAN MAIN ST
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City | MADISON
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State | IN
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Zip | 47250-8489
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Country | US
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Telephone | 812-839-0003
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | DONNA TAYLOR
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Credential |
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Telephone | 812-839-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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