Provider Demographics
NPI:1235652959
Name:WATERSHED AND ARK OF SALVATION MINISTRIES
Entity Type:Organization
Organization Name:WATERSHED AND ARK OF SALVATION MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:EBUN
Authorized Official - Last Name:OGUNLOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-575-0858
Mailing Address - Street 1:5265 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1720
Mailing Address - Country:US
Mailing Address - Phone:267-575-0858
Mailing Address - Fax:
Practice Address - Street 1:5265 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1720
Practice Address - Country:US
Practice Address - Phone:267-575-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA33853601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA33853601OtherHOME CARE AGENCY