Provider Demographics
NPI:1588008643
Name:WORDSWORTH
Entity Type:Organization
Organization Name:WORDSWORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-643-5400
Mailing Address - Street 1:3905 FORD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2824
Mailing Address - Country:US
Mailing Address - Phone:215-643-5400
Mailing Address - Fax:215-871-3412
Practice Address - Street 1:2101 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2912
Practice Address - Country:US
Practice Address - Phone:800-769-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1407806433Medicaid