Provider Demographics
NPI:1740713056
Name:ACCESS DIRECT SUPPORT COORDINATION INC.
Entity type:Organization
Organization Name:ACCESS DIRECT SUPPORT COORDINATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSHCHYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-512-9400
Mailing Address - Street 1:696 2ND STREET PIKE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1068
Mailing Address - Country:US
Mailing Address - Phone:267-800-9800
Mailing Address - Fax:215-645-5114
Practice Address - Street 1:696 2ND STREET PIKE
Practice Address - Street 2:SUITE 302
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1068
Practice Address - Country:US
Practice Address - Phone:267-800-9800
Practice Address - Fax:215-645-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031084950002Medicaid