Provider Demographics
NPI:1225261084
Name:ST. JOHN'S COMMUNITY SERVICES
Entity Type:Organization
Organization Name:ST. JOHN'S COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-238-9540
Mailing Address - Street 1:520 N COLUMBUS BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4226
Mailing Address - Country:US
Mailing Address - Phone:267-238-9540
Mailing Address - Fax:215-451-5073
Practice Address - Street 1:520 N COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4226
Practice Address - Country:US
Practice Address - Phone:267-238-9540
Practice Address - Fax:215-451-5073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOHN'S COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services