Provider Demographics
NPI:1013483411
Name:A-1 CARE COORDINATION LLC
Entity Type:Organization
Organization Name:A-1 CARE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:OLUMUYIWA
Authorized Official - Last Name:OMOJOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-462-9485
Mailing Address - Street 1:27 SOUTH 5TH STREET, DARBY PA 19023
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1204
Mailing Address - Country:US
Mailing Address - Phone:678-462-9485
Mailing Address - Fax:
Practice Address - Street 1:527B ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:FOLCROFT
Practice Address - State:PA
Practice Address - Zip Code:19032-1204
Practice Address - Country:US
Practice Address - Phone:678-462-9485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA831417668Medicaid