Provider Demographics
NPI:1346653672
Name:ABILITY NETWORK
Entity Type:Organization
Organization Name:ABILITY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON-BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-883-8181
Mailing Address - Street 1:379 EL TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-4338
Mailing Address - Country:US
Mailing Address - Phone:573-280-6258
Mailing Address - Fax:
Practice Address - Street 1:284 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1610
Practice Address - Country:US
Practice Address - Phone:573-883-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001021506253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care