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General NPI Number Information
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NPI Number | 1780830133
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Entity Type | Organization
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Legal Business Name | HARVEST OUTREACH CENTER, INC
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 410 MADDOX RD
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City | GLADYS
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State | VA
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Zip | 24554-3030
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Country | US
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Telephone | 434-283-5340
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Fax |
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Provider Business Mailing Address
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Address Line | 410 MADDOX RD
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City | GLADYS
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State | VA
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Zip | 24554-3030
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Country | US
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Telephone | 434-283-5340
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | TRACY FOSTER
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Credential |
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Telephone | 434-283-3679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1205
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License Number State | VA
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