Healthcare Provider Details

I. General information

NPI: 1730009812
Provider Name (Legal Business Name): ACACIA COMMUNITY ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ROCK CREEK DR
WYNCOTE PA
19095-2013
US

IV. Provider business mailing address

1115 ROCK CREEK DR
WYNCOTE PA
19095-2013
US

V. Phone/Fax

Practice location:
  • Phone: 267-223-5016
  • Fax:
Mailing address:
  • Phone: 267-223-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MARQUITA ATKINSON
Title or Position: DIRECTOR
Credential:
Phone: 267-223-5016