Provider Demographics
NPI:1003574708
Name:AICM LLC
Entity Type:Organization
Organization Name:AICM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THOMAISINA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-540-0851
Mailing Address - Street 1:18 PHILADELPHIA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2798
Mailing Address - Country:US
Mailing Address - Phone:443-355-8539
Mailing Address - Fax:
Practice Address - Street 1:18 PHILADELPHIA AVE APT 4
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2798
Practice Address - Country:US
Practice Address - Phone:443-355-8539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution