Provider Demographics
NPI:1487005609
Name:INTERVENTION FUNDAMENTALS
Entity Type:Organization
Organization Name:INTERVENTION FUNDAMENTALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-438-3268
Mailing Address - Street 1:229 LIBERTO RD
Mailing Address - Street 2:
Mailing Address - City:PENN HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15235-2065
Mailing Address - Country:US
Mailing Address - Phone:412-438-3268
Mailing Address - Fax:
Practice Address - Street 1:229 LIBERTO RD
Practice Address - Street 2:
Practice Address - City:PENN HILLS
Practice Address - State:PA
Practice Address - Zip Code:15235-2065
Practice Address - Country:US
Practice Address - Phone:412-438-3268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002964251C00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency