Provider Demographics
NPI:1891379962
Name:PHENOMENAL MINDS DAYCARE CENTER LLC
Entity Type:Organization
Organization Name:PHENOMENAL MINDS DAYCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHUNE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:267-586-4820
Mailing Address - Street 1:5718 RISING SUN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1631
Mailing Address - Country:US
Mailing Address - Phone:267-586-4820
Mailing Address - Fax:
Practice Address - Street 1:5718 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1631
Practice Address - Country:US
Practice Address - Phone:267-586-4820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care