=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821225954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARROWHEAD HEAD START
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2009
-----------------------------------------------------
Last Update Date | 06/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 702 S 3RD AVE
-----------------------------------------------------
City | VIRGINIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55792-2775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-749-2912
-----------------------------------------------------
Fax | 218-749-2944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 702 S 3RD AVE
-----------------------------------------------------
City | VIRGINIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55792-2775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-749-2912
-----------------------------------------------------
Fax | 218-749-2944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEAD START DIRECTOR
-----------------------------------------------------
Name | MR. NORMAN E. FERRIS III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-749-2912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------