Provider Demographics
NPI:1760002000
Name:SPILOVE PHILADELPHIA, LLC
Entity Type:Organization
Organization Name:SPILOVE PHILADELPHIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, RYT-500
Authorized Official - Phone:484-532-3447
Mailing Address - Street 1:1601 WALNUT ST STE 1007
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2906
Mailing Address - Country:US
Mailing Address - Phone:484-532-3447
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST STE 1007
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2906
Practice Address - Country:US
Practice Address - Phone:484-532-3447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIFFANY SPILOVE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)