Healthcare Provider Details

I. General information

NPI: 1629749791
Provider Name (Legal Business Name): 412 FOSTER PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 LINCOLN AVE
BELLEVUE PA
15202-3531
US

IV. Provider business mailing address

924 LIMESTONE DR
ALLISON PARK PA
15101-4228
US

V. Phone/Fax

Practice location:
  • Phone: 412-874-6015
  • Fax:
Mailing address:
  • Phone: 412-874-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNA BOSI
Title or Position: CEO/DIRECTOR
Credential:
Phone: 412-874-6015