Provider Demographics
NPI:1508458571
Name:NAITRE CORPORATION
Entity Type:Organization
Organization Name:NAITRE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEMETRE
Authorized Official - Middle Name:
Authorized Official - Last Name:POUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-879-1616
Mailing Address - Street 1:6817 OAKLEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3914
Mailing Address - Country:US
Mailing Address - Phone:267-879-1616
Mailing Address - Fax:
Practice Address - Street 1:1753 S RINGGOLD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-1808
Practice Address - Country:US
Practice Address - Phone:267-879-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health