Provider Demographics
NPI:1407104979
Name:IFC MENTAL RETARDATION SERVICES, INC.
Entity Type:Organization
Organization Name:IFC MENTAL RETARDATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:814-542-9282
Mailing Address - Street 1:20 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT UNION
Mailing Address - State:PA
Mailing Address - Zip Code:17066-1267
Mailing Address - Country:US
Mailing Address - Phone:814-542-9282
Mailing Address - Fax:814-514-1022
Practice Address - Street 1:20 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MOUNT UNION
Practice Address - State:PA
Practice Address - Zip Code:17066-1267
Practice Address - Country:US
Practice Address - Phone:814-542-9282
Practice Address - Fax:814-514-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA310890251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001646OtherDEPARTMENT OF PUBLIC WELFARE MASTER PROVIDER INDEX