Provider Demographics
NPI:1255765087
Name:DEVELOPER OF OPTIMISM SUPPORT
Entity type:Organization
Organization Name:DEVELOPER OF OPTIMISM SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY INCLUSION
Authorized Official - Prefix:MISS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-333-4525
Mailing Address - Street 1:6225 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-3213
Mailing Address - Country:US
Mailing Address - Phone:215-333-4525
Mailing Address - Fax:
Practice Address - Street 1:6225 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3213
Practice Address - Country:US
Practice Address - Phone:215-333-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services