Provider Demographics
NPI:1881289163
Name:A TIME TO REMEMBER LLC
Entity type:Organization
Organization Name:A TIME TO REMEMBER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAQUITHA
Authorized Official - Middle Name:SHANTELL
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-323-1676
Mailing Address - Street 1:1300 N CHARLOTTE ST STE 10
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-2351
Mailing Address - Country:US
Mailing Address - Phone:610-323-1676
Mailing Address - Fax:
Practice Address - Street 1:1300 N CHARLOTTE ST STE 10
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-2351
Practice Address - Country:US
Practice Address - Phone:610-323-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103848748Medicaid
PA103848748-0001Medicaid