Provider Demographics
NPI:1417286584
Name:ADONNYA'S ANGEL ATTIC
Entity Type:Organization
Organization Name:ADONNYA'S ANGEL ATTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:RNBSN
Authorized Official - Phone:215-500-5707
Mailing Address - Street 1:116 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3803
Mailing Address - Country:US
Mailing Address - Phone:215-500-5707
Mailing Address - Fax:
Practice Address - Street 1:116 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:ALDAN
Practice Address - State:PA
Practice Address - Zip Code:19018-3803
Practice Address - Country:US
Practice Address - Phone:215-500-5707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN310515L261Q00000X, 261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN310515LOtherCOMMONWEALTH OF PENNSYLVANIA