Provider Demographics
NPI:1659816759
Name:FUNCTION WHEELS LLC
Entity Type:Organization
Organization Name:FUNCTION WHEELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:AMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:914-292-5150
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-0186
Mailing Address - Country:US
Mailing Address - Phone:914-292-5150
Mailing Address - Fax:
Practice Address - Street 1:639 E 234TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2701
Practice Address - Country:US
Practice Address - Phone:914-292-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)