Provider Demographics
NPI:1063982148
Name:FISHERS OF KNOWLEDGE SPECIAL BEGINNINGS INC
Entity type:Organization
Organization Name:FISHERS OF KNOWLEDGE SPECIAL BEGINNINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENZENIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA ED
Authorized Official - Phone:267-626-7361
Mailing Address - Street 1:PO BOX 30221
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027
Mailing Address - Country:US
Mailing Address - Phone:267-626-7361
Mailing Address - Fax:
Practice Address - Street 1:8305 - 15 RIDGE AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2113
Practice Address - Country:US
Practice Address - Phone:267-626-7361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No252Y00000XAgenciesEarly Intervention Provider Agency