Provider Demographics
NPI:1255578928
Name:CITY OF PHILA
Entity type:Organization
Organization Name:CITY OF PHILA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-685-6792
Mailing Address - Street 1:7979 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3407
Mailing Address - Country:US
Mailing Address - Phone:215-685-6790
Mailing Address - Fax:215-685-6848
Practice Address - Street 1:500 S BROAD ST
Practice Address - Street 2:AMBULATORY HEALTH SERVICES
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19146-1613
Practice Address - Country:US
Practice Address - Phone:215-685-6792
Practice Address - Fax:215-685-6848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF PHILA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA144730311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility