Provider Demographics
NPI:1124204904
Name:NATIONAL NURSING CENTERS CONSORTIUM
Entity Type:Organization
Organization Name:NATIONAL NURSING CENTERS CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN-TURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MGA
Authorized Official - Phone:215-731-7140
Mailing Address - Street 1:260 S BROAD ST
Mailing Address - Street 2:18TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-5021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 S BROAD ST
Practice Address - Street 2:18TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-5021
Practice Address - Country:US
Practice Address - Phone:215-731-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1016137600001OtherMEDICARE ID