=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518280148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN AND FAMILY COMMUNITY DEVELOPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2010
-----------------------------------------------------
Last Update Date | 03/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2623 N. MAIN ST. CHILDREN & FAMILY COMMUNITY DEVELOPMENT
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-943-9106
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | POST OFFICE BOX 1116 700 EAST MAIN ST.
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-943-9106
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SHIRLEY JEAN PURNELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-943-9106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 1182-05-001
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------