Provider Demographics
NPI:1417327305
Name:BARBARA GILLIAM
Entity Type:Organization
Organization Name:BARBARA GILLIAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-847-7061
Mailing Address - Street 1:6243 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5705
Mailing Address - Country:US
Mailing Address - Phone:215-847-7061
Mailing Address - Fax:215-722-2354
Practice Address - Street 1:6243 LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5705
Practice Address - Country:US
Practice Address - Phone:215-847-7061
Practice Address - Fax:215-722-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services