Provider Demographics
NPI:1962911990
Name:INFANT AND TODDLER CONNECTION OF THE HEARTLAND
Entity type:Organization
Organization Name:INFANT AND TODDLER CONNECTION OF THE HEARTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, ADMIN & FINANCE & CBO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:KEN
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-395-2016
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901
Mailing Address - Country:US
Mailing Address - Phone:434-395-2967
Mailing Address - Fax:434-395-2969
Practice Address - Street 1:315 WEST THIRD STREET
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-395-2967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty