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General NPI Number Information
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NPI Number | 1659816759
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Entity Type | Organization
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Legal Business Name | FUNCTION WHEELS LLC
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Dates
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Enumeration Date | 12/27/2016
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 639 E 234TH ST
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City | BRONX
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State | NY
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Zip | 10466-2701
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Country | US
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Telephone | 914-292-5150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 186
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-0186
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Country | US
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Telephone | 914-292-5150
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF EDUCATION
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Name | MR. KEITH DARNELL AMERSON
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Credential | M.S.ED
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Telephone | 914-292-5150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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