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General NPI Number Information
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NPI Number | 1760545057
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Entity Type | Organization
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Legal Business Name | WESCO INDUSTRIES
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 415 S 11TH ST
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City | DENISON
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State | IA
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Zip | 51442-2451
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Country | US
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Telephone | 712-263-6141
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Fax | 712-263-4886
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Provider Business Mailing Address
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Address Line | 415 S 11TH ST P.O. BOX 340
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City | DENISON
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State | IA
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Zip | 51442-2451
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Country | US
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Telephone | 712-263-6141
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Fax | 712-263-4886
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AMANDA BREWER
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Credential |
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Telephone | 712-263-6141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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