MEDICARE: WORDSWORTH

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
1	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588008643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORDSWORTH

Provider Business Mailing Address
First Line	:	3905 FORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2824
Country	:	US
Telephone Number	:	215-643-5400
Fax Number	:	215-871-3412

Provider Business Practice Location Address
First Line	:	2101 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2912
Country	:	US
Telephone Number	:	800-769-0088
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEBRA LACKS
Credential	:
Telephone Number	:	215-643-5400

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/19/2013

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Directions to “WORDSWORTH ” Practice Location

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