Provider Demographics
NPI:1184131096
Name:AVENUES OF HOPE- CHAPTER 3800
Entity type:Organization
Organization Name:AVENUES OF HOPE- CHAPTER 3800
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KABIRU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-560-6600
Mailing Address - Street 1:4949 LIBERTY LN STE 350
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4949 LIBERTY LN STE 350
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9018
Practice Address - Country:US
Practice Address - Phone:484-560-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1194267914
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103226381Medicaid