Provider Demographics
NPI:1922303601
Name:AMUDIPES OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:AMUDIPES OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-858-7685
Mailing Address - Street 1:90 NORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2802
Mailing Address - Country:US
Mailing Address - Phone:215-858-7685
Mailing Address - Fax:
Practice Address - Street 1:5111 DOLPHIN LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3101
Practice Address - Country:US
Practice Address - Phone:704-531-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health