Healthcare Provider Details

I. General information

NPI: 1720455264
Provider Name (Legal Business Name): FAMILY SUPPORT CIRCLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 E CHELTEN AVE
PHILADELPHIA PA
19138-3043
US

IV. Provider business mailing address

2059 E CHELTEN AVE
PHILADELPHIA PA
19138-3043
US

V. Phone/Fax

Practice location:
  • Phone: 267-335-5857
  • Fax: 267-385-6119
Mailing address:
  • Phone: 267-335-5857
  • Fax: 267-385-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number22343601
License Number StatePA

VIII. Authorized Official

Name: DR. ELNA POULARD
Title or Position: PRESIDENT
Credential: PHD
Phone: 404-917-9765