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General NPI Number Information
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NPI Number | 1295516235
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Entity Type | Organization
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Legal Business Name | DEVELOPMENT ACADEMY CORPORATION
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 5601 WILKE FARM AVE
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City | LOUISVILLE
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State | KY
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Zip | 40216-1289
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Country | US
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Telephone | 502-910-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 2414 ARTHUR ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-9577
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Country | US
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Telephone | 502-910-1117
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JARVIS NELSON PEELE
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Credential |
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Telephone | 502-910-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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