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General NPI Number Information
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NPI Number | 1295067429
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Entity Type | Organization
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Legal Business Name | FRIENDS OF ADVOCATE
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Dates
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Enumeration Date | 02/14/2010
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Last Update Date | 02/15/2010
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Provider Practice Location Address
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Address Line | 2605 E MAIN ST
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City | DANVILLE
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State | IN
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Zip | 46122-8468
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Country | US
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Telephone | 317-745-5147
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Fax | 317-745-5936
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Provider Business Mailing Address
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Address Line | 2605 E MAIN ST
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City | DANVILLE
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State | IN
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Zip | 46122-8468
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Country | US
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Telephone | 317-745-5147
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Fax | 317-745-5936
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LINDA S RICHARDSON
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Credential | RN
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Telephone | 317-745-5147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 71002615A
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License Number State | IN
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