MEDICARE: IFC MENTAL RETARDATION SERVICES, 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	251C00000X	Developmentally Disabled Services Day Training Agency	310890	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100001646	OTHER	PA	DEPARTMENT OF PUBLIC WELFARE MASTER PROVIDER INDEX

General Provider Information

NPI Number	:	1407104979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IFC MENTAL RETARDATION SERVICES, INC.

Provider Business Mailing Address
First Line	:	20 N JEFFERSON ST
Second Line	:
City	:	MOUNT UNION
State	:	PA
Zip	:	17066-1267
Country	:	US
Telephone Number	:	814-542-9282
Fax Number	:	814-514-1022

Provider Business Practice Location Address
First Line	:	20 N JEFFERSON ST
Second Line	:
City	:	MOUNT UNION
State	:	PA
Zip	:	17066-1267
Country	:	US
Telephone Number	:	814-542-9282
Fax Number	:	814-514-1022

Authorized Official
Title or Position	:	CEO
Name	:	MS. KAREN BOWER
Credential	:	MSW, LSW
Telephone Number	:	814-542-9282

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

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