Healthcare Provider Details

I. General information

NPI: 1669942736
Provider Name (Legal Business Name): PHILADELPHIA RONALD MCDONALD HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 12/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 CHESTNUT ST
PHILADELPHIA PA
19104-3110
US

IV. Provider business mailing address

3925 CHESTNUT ST
PHILADELPHIA PA
19104-3110
US

V. Phone/Fax

Practice location:
  • Phone: 267-969-6202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: LAUREEN MENDELERO
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 267-969-6202