Provider Demographics
NPI:1255630588
Name:EDBECO
Entity type:Organization
Organization Name:EDBECO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHEPULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-836-1383
Mailing Address - Street 1:1811 BETHLEHEM PIKE
Mailing Address - Street 2:BLDG B-1 SUITE 211
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1111
Mailing Address - Country:US
Mailing Address - Phone:215-836-1383
Mailing Address - Fax:215-836-1384
Practice Address - Street 1:1811 BETHLEHEM PIKE
Practice Address - Street 2:BLDG B-1 SUITE 211
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1111
Practice Address - Country:US
Practice Address - Phone:215-836-1383
Practice Address - Fax:215-836-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health