=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841439528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUILDING BLOCKS COMPREHENSIVE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2009
-----------------------------------------------------
Last Update Date | 02/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 275 PARRISH ST SUITE A
-----------------------------------------------------
City | CANANDAIGUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14424-1785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-393-0554
-----------------------------------------------------
Fax | 585-393-0676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 275 PARRISH ST SUITE A
-----------------------------------------------------
City | CANANDAIGUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14424-1785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-393-0554
-----------------------------------------------------
Fax | 585-393-0676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. KELLY G BATEMAN
-----------------------------------------------------
Credential | MSED, OTR/L
-----------------------------------------------------
Telephone | 585-393-0554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------