=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710255195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FABBRI ENTERPRISES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2011
-----------------------------------------------------
Last Update Date | 12/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 GRAND CENTRAL AVE SUITE 10
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26105-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-295-8222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 GRAND CENTRAL AVE SUITE 10
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26105-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-295-8222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. KELLY FABBRI
-----------------------------------------------------
Credential | MA, CCC-SLP
-----------------------------------------------------
Telephone | 304-488-7138
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 22126026
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------