Provider Demographics
NPI:1851868442
Name:FIRELY PEDIATRIC SERVICES INC.
Entity Type:Organization
Organization Name:FIRELY PEDIATRIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEKSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-513-7455
Mailing Address - Street 1:364 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2212
Mailing Address - Country:US
Mailing Address - Phone:155-137-4552
Mailing Address - Fax:
Practice Address - Street 1:254 BRYANS RD
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1306
Practice Address - Country:US
Practice Address - Phone:484-322-2403
Practice Address - Fax:484-322-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA144380Medicaid