=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861850596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. CINDY LOU POORE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2016
-----------------------------------------------------
Last Update Date | 02/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2285 KNOB CHURCH RD
-----------------------------------------------------
City | HENRY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24102-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-365-9907
-----------------------------------------------------
Fax | 540-365-0511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2285 KNOB CHURCH RD
-----------------------------------------------------
City | HENRY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24102-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-365-9907
-----------------------------------------------------
Fax | 540-365-0511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------