MEDICARE: FISHERS OF KNOWLEDGE SPECIAL BEGINNINGS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency
2	261QM3000X	Medically Fragile Infants and Children Day Care

General Provider Information

NPI Number	:	1063982148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHERS OF KNOWLEDGE SPECIAL BEGINNINGS INC

Provider Business Mailing Address
First Line	:	PO BOX 30221
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027
Country	:	US
Telephone Number	:	267-626-7361
Fax Number	:

Provider Business Practice Location Address
First Line	:	8305 - 15 RIDGE AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2113
Country	:	US
Telephone Number	:	267-626-7361
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BENZENIA D DRAKE
Credential	:	M.A. ED.
Telephone Number	:	267-626-7361

Provider Enumeration Date	:	11/30/2018
Last Update Date	:	01/09/2019

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