Healthcare Provider Details

I. General information

NPI: 1447943022
Provider Name (Legal Business Name): C BASE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 WITLER ST
PHILADELPHIA PA
19115-2609
US

IV. Provider business mailing address

1933 WITLER ST
PHILADELPHIA PA
19115-2609
US

V. Phone/Fax

Practice location:
  • Phone: 917-622-4609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: CELINA LEE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 917-622-4609