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NPI Code Detail

MEDICARE: RIVER WARDS WELLNESS COLLECTIVE

MEDICARE: RIVER WARDS WELLNESS COLLECTIVE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1538637327
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVER WARDS WELLNESS COLLECTIVE
Provider Business Mailing Address
First Line : 158 W THOMPSON ST APT 8
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19122-4635
Country : US
Telephone Number : 267-261-8061
Fax Number :
Provider Business Practice Location Address
First Line : 2566 FRANKFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-1743
Country : US
Telephone Number : 267-261-8061
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SARAH DISANTO
Credential :
Telephone Number : 267-261-8061
Provider Enumeration Date : 11/09/2018
Last Update Date : 11/09/2018

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Directions to “RIVER WARDS WELLNESS COLLECTIVE ” Practice Location

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