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General NPI Number Information
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NPI Number | 1043916042
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Entity Type | Organization
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Legal Business Name | COMMUCARE
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 1841 CHURCH LN FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19141-1319
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Country | US
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Telephone | 267-816-3449
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Fax |
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Provider Business Mailing Address
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Address Line | 630 E STAFFORD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19144-1250
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Country | US
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Telephone | 267-816-3449
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KRISTIAN AKIYA LATIMORE
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Credential |
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Telephone | 267-816-3449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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