Provider Demographics
NPI:1356754675
Name:KNOX COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
Entity type:Organization
Organization Name:KNOX COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-886-4312
Mailing Address - Street 1:2525 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2405
Mailing Address - Country:US
Mailing Address - Phone:812-886-4312
Mailing Address - Fax:812-886-4844
Practice Address - Street 1:2900 E ARC AVE
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-6888
Practice Address - Country:US
Practice Address - Phone:812-886-4312
Practice Address - Fax:812-886-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003141A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200714610AMedicaid
IN100229180AMedicaid
IN200363140AMedicaid
IN100243240AMedicaid
IN100233980AMedicaid
IN200433130AMedicaid
IN100249470AMedicaid
IN200333060AMedicaid
IN200333130AMedicaid