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Organization
FIVCO ADD CDO AS FISCAL AGENT
Active
Organization
FIVCO ADD CDO AS FISCAL AGENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY MCDAVID (EXECUTIVE DIRECTOR)
(606) 929-1366
Entity
Organization
Contact information
Practice address
1212 BATH AVE, SUITE 650, ASHLAND, KY 41101-2696
(606) 929-1366
(606) 327-0023
Mailing address
1212 BATH AVE, SUITE 650, ASHLAND, KY 41101-2696
(606) 929-1366
(606) 327-0023
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17000811
—
KY
05
—
33001447
—
KY
05
—
43996107
—
KY
Enumeration date
05/29/2007
Last updated
08/22/2020
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