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General NPI Number Information
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NPI Number | 1811100647
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Entity Type | Organization
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Legal Business Name | HANNA COMMUNITY COUNCIL
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 1201 N 18TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2267
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Country | US
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Telephone | 765-742-0191
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Fax | 765-742-0271
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Provider Business Mailing Address
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Address Line | 1201 N 18TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2267
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Country | US
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Telephone | 765-742-0191
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Fax | 765-742-0271
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ANGELA GRAYSON
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Credential |
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Telephone | 765-742-0191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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