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General NPI Number Information
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NPI Number | 1376285270
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Entity Type | Organization
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Legal Business Name | FATHERS FOREVER COALITION, INC
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 1129 16TH ST
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City | BEDFORD
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State | IN
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Zip | 47421-3721
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Country | US
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Telephone | 812-329-6941
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Fax | 812-675-8416
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Provider Business Mailing Address
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Address Line | 1129 16TH ST
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City | BEDFORD
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State | IN
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Zip | 47421-3721
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Country | US
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Telephone | 812-329-6941
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF WELLNESS AND RECOVERY
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Name | CASEY M DEROSSETT
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Credential |
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Telephone | 812-278-7590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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