Healthcare Provider Details

I. General information

NPI: 1730399064
Provider Name (Legal Business Name): METROPOLITAN AREA NEIGHBORHOOD NUTRITION ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N 20TH ST
PHILADELPHIA PA
19130-3828
US

IV. Provider business mailing address

420 N 20TH ST
PHILADELPHIA PA
19130-3828
US

V. Phone/Fax

Practice location:
  • Phone: 215-496-2662
  • Fax: 215-496-1349
Mailing address:
  • Phone: 215-496-2662
  • Fax: 215-496-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN DAUGHERTY
Title or Position: CEO
Credential: R.D.
Phone: 215-496-2662