Provider Demographics
NPI:1568502094
Name:HOME OF THE MERCIFUL SAVIOUR FOR CRIPPLED CHILDREN
Entity Type:Organization
Organization Name:HOME OF THE MERCIFUL SAVIOUR FOR CRIPPLED CHILDREN
Other - Org Name:HMS SCHOOL FOR CHILDREN WITH CP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN ASST - SBAP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-222-2566
Mailing Address - Street 1:4400 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4440
Mailing Address - Country:US
Mailing Address - Phone:215-222-2566
Mailing Address - Fax:215-222-1889
Practice Address - Street 1:4400 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4440
Practice Address - Country:US
Practice Address - Phone:215-222-2566
Practice Address - Fax:215-222-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013059660001Medicaid