Fourth Avenue Homes Inc.

NPI #1205012507 in Spicer, Minnesota

Provider Information

NPI Number: 1205012507
Entity Type: Organization
Organization Name: Fourth Avenue Homes Inc.
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Jan 16, 2008
Last Updated: Apr 15, 2008

Practice Location

Address: 140 4TH AVE
City: Spicer
State: Minnesota
ZIP Code: 56288-9673
Phone: (320) 796-2905

Authorized Official

Name: DEBRA JOANNE SHRIVER
Title: CEO
Phone: (320) 231-2738

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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