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General NPI Number Information
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NPI Number | 1356754675
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Entity Type | Organization
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Legal Business Name | KNOX COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 2900 E ARC AVE
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City | VINCENNES
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State | IN
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Zip | 47591-6888
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Country | US
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Telephone | 812-886-4312
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Fax | 812-886-4844
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Provider Business Mailing Address
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Address Line | 2525 N 6TH ST
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City | VINCENNES
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State | IN
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Zip | 47591-2405
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Country | US
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Telephone | 812-886-4312
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Fax | 812-886-4844
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Authorized Official
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Title or Position | VP BUSINESS FINANCE
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Name | JUDITH KOTTER
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Credential |
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Telephone | 812-886-4312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22003141A
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License Number State | IN
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