=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568150977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEARFIELD EDUCATION FOUNDATION-FURTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2023
-----------------------------------------------------
Last Update Date | 04/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8904 CLEARFIELD CURWENSVILLE HWY
-----------------------------------------------------
City | CLEARFIELD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16830-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-205-4077
-----------------------------------------------------
Fax | 814-205-4078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 209
-----------------------------------------------------
City | CLEARFIELD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16830-0209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-205-4077
-----------------------------------------------------
Fax | 814-205-4078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN ASSIST
-----------------------------------------------------
Name | BRANDY EVANS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-205-4077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------