1356754675 NPI number — KNOX COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.

Table of content: (NPI 1356754675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356754675 NPI number — KNOX COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNOX COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356754675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 N 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VINCENNES
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47591-2405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-886-4312
Provider Business Mailing Address Fax Number:
812-886-4844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 E ARC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINCENNES
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47591-6888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-886-4312
Provider Business Practice Location Address Fax Number:
812-886-4844
Provider Enumeration Date:
06/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KOTTER
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
VP BUSINESS FINANCE
Authorized Official Telephone Number:
812-886-4312

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  22003141A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200714610A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100229180A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200363140A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100243240A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100233980A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200433130A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100249470A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200333060A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200333130A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com