Healthcare Provider Details

I. General information

NPI: 1669728630
Provider Name (Legal Business Name): POTENTIAL DISCOVERIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 N. YORK RD SUITE 220
WILLOW GROVE PA
19090
US

IV. Provider business mailing address

349 N. YORK RD SUITE 220
WILLOW GROVE PA
19090
US

V. Phone/Fax

Practice location:
  • Phone: 484-477-6587
  • Fax:
Mailing address:
  • Phone: 484-477-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-09-5862
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1-09-5862
License Number StatePA

VIII. Authorized Official

Name: MISS NAJAH BROWN
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 484-477-6587