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General NPI Number Information
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NPI Number | 1134663024
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Entity Type | Organization
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Legal Business Name | MEN MAKERS LLC
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 301 COBBS CREEK PKWY
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1016
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Country | US
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Telephone | 267-242-0939
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Fax | 215-474-5098
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Provider Business Mailing Address
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Address Line | 301 COBBS CREEK PKWY
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1016
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Country | US
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Telephone | 267-242-0939
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Fax | 215-474-5098
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BERNARD SHEMAIAH COLLINS
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Credential | MSW
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Telephone | 267-242-0939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | BH001116
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License Number State | PA
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