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General NPI Number Information
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NPI Number | 1992020416
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Entity Type | Organization
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Legal Business Name | DARWIN'S HEALTH CLUB, INC
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 47-53 WATER STREET
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City | FREDONIA
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State | NY
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Zip | 14063
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Country | US
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Telephone | 716-679-1591
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Fax | 716-679-1592
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Provider Business Mailing Address
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Address Line | 47-53 WATER STREET
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City | FREDONIA
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State | NY
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Zip | 14063
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Country | US
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Telephone | 716-679-1591
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Fax | 716-679-1592
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Authorized Official
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Title or Position | MANAGER/BOOKKEEPER
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Name | MRS. CATHERINE S PRATT
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Credential |
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Telephone | 716-679-1591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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