Provider Demographics
NPI:1538331608
Name:FAITH & HOPE BOUTIQUE, LLC
Entity Type:Organization
Organization Name:FAITH & HOPE BOUTIQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALFARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-885-1143
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:PERELMAN CTR. 1W SUITE 680
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-615-3321
Mailing Address - Fax:215-615-3348
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:PERELMAN CTR. 1W SUITE 680
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-615-3321
Practice Address - Fax:215-615-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-29
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6296530001Medicare NSC