Provider Demographics
NPI:1285055707
Name:FICO INNOVATIVE CHOICES
Entity type:Organization
Organization Name:FICO INNOVATIVE CHOICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SPIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-233-8737
Mailing Address - Street 1:253 KRETCHMAN FARM RD
Mailing Address - Street 2:
Mailing Address - City:MEYERSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15552-6134
Mailing Address - Country:US
Mailing Address - Phone:814-233-8737
Mailing Address - Fax:814-634-0546
Practice Address - Street 1:253 KRETCHMAN FARM RD
Practice Address - Street 2:
Practice Address - City:MEYERSDALE
Practice Address - State:PA
Practice Address - Zip Code:15552-6134
Practice Address - Country:US
Practice Address - Phone:814-233-8737
Practice Address - Fax:814-634-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services