Provider Demographics
NPI:1760865711
Name:AMPERSAND HEALTH-PA, LLC
Entity Type:Organization
Organization Name:AMPERSAND HEALTH-PA, LLC
Other - Org Name:CITYLIFE NEIGHBORHOOD CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-708-4487
Mailing Address - Street 1:2020 21ST AVE S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4354
Mailing Address - Country:US
Mailing Address - Phone:615-708-4487
Mailing Address - Fax:
Practice Address - Street 1:3945 CHESTNUT ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3621
Practice Address - Country:US
Practice Address - Phone:615-708-4487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMPERSAND HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care