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General NPI Number Information
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NPI Number | 1073999413
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Entity Type | Organization
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Legal Business Name | ADVANGARDE
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Dates
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Enumeration Date | 08/08/2015
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Last Update Date | 08/08/2015
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Provider Practice Location Address
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Address Line | 604 S WASHINGTON SQ
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4118
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Country | US
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Telephone | 609-254-0626
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Fax | 609-254-0621
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Provider Business Mailing Address
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Address Line | 604 S WASHINGTON SQ
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4118
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Country | US
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Telephone | 609-254-0626
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Fax | 609-254-0621
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SCOTT WINSTON CARTER
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Credential | PA
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Telephone | 609-254-0626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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