Healthcare Provider Details

I. General information

NPI: 1992685838
Provider Name (Legal Business Name): FRUITS OF THE FAMILY TABLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 ARCH STREET SUITE 1700
PHILADELPHIA PA
19104-2857
US

IV. Provider business mailing address

2929 ARCH STREET SUITE 1700
PHILADELPHIA PA
19104-2857
US

V. Phone/Fax

Practice location:
  • Phone: 267-410-6188
  • Fax:
Mailing address:
  • Phone: 267-410-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARELL WINONA WILSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 267-760-3807