Provider Demographics
NPI:1033590815
Name:NATIONAL CARE HUMAN SERVICES LLC
Entity Type:Organization
Organization Name:NATIONAL CARE HUMAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-333-3608
Mailing Address - Street 1:2300 COMPUTER RD STE A5
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1733
Mailing Address - Country:US
Mailing Address - Phone:215-346-2499
Mailing Address - Fax:215-383-5038
Practice Address - Street 1:2300 COMPUTER RD STE A5
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1733
Practice Address - Country:US
Practice Address - Phone:215-346-2499
Practice Address - Fax:215-383-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA102891566320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102891566Medicaid