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General NPI Number Information
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NPI Number | 1063895571
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Entity Type | Organization
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Legal Business Name | JAMES NATHANIEL
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 9 W PHIL ELLENA ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2725
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Country | US
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Telephone | 267-334-9523
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Fax |
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Provider Business Mailing Address
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Address Line | 9 W. PHIL-ELLENA STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19119
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Country | US
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Telephone | 267-334-9523
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES L NATHANIEL JR.
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Credential |
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Telephone | 267-334-9523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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