Provider Demographics
NPI:1386715597
Name:CARVER COMMUNITY ORGANIZATION, INC.
Entity type:Organization
Organization Name:CARVER COMMUNITY ORGANIZATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-423-2612
Mailing Address - Street 1:504 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1743
Mailing Address - Country:US
Mailing Address - Phone:812-423-2612
Mailing Address - Fax:812-423-6941
Practice Address - Street 1:504 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1743
Practice Address - Country:US
Practice Address - Phone:812-423-2612
Practice Address - Fax:812-423-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care