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General NPI Number Information
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NPI Number | 1689961740
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Entity Type | Organization
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Legal Business Name | LARSON ENTERPRISE, INC
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 353 PINE ST SUITE 2
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-6257
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Country | US
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Telephone | 570-322-1414
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Fax | 570-329-3693
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Provider Business Mailing Address
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Address Line | 353 PINE ST SUITE 2
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-6257
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Country | US
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Telephone | 570-322-1414
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Fax | 570-329-3693
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ANDRIA LARSON
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Credential |
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Telephone | 570-322-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 10103601
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License Number State | PA
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