Healthcare Provider Details
I. General information
NPI: 1790219988
Provider Name (Legal Business Name): SWC FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3933 PERKIOMEN AVE SUITE 101
READING PA
19606-2756
US
IV. Provider business mailing address
3933 PERKIOMEN AVE SUITE 101
READING PA
19606-2756
US
V. Phone/Fax
- Phone: 610-779-4588
- Fax: 610-779-8040
- Phone: 610-779-4588
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | UP006288B |
| License Number State | PA |
VIII. Authorized Official
Name: DR.
PATRICK
M
BORJA
Title or Position: OWNER
Credential: D.C.
Phone: 610-779-4588