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General NPI Number Information
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NPI Number | 1801097993
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Entity Type | Organization
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Legal Business Name | FIVCO ADD CDO AS FISCAL AGENT
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1212 BATH AVE SUITE 650
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City | ASHLAND
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State | KY
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Zip | 41101-2696
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Country | US
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Telephone | 606-929-1366
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Fax | 606-327-0023
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Provider Business Mailing Address
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Address Line | 1212 BATH AVE SUITE 650
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City | ASHLAND
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State | KY
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Zip | 41101-2696
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Country | US
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Telephone | 606-929-1366
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Fax | 606-327-0023
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHERRY MCDAVID
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Credential |
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Telephone | 606-929-1366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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