=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154800472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENNSYLVANIA CARE ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2018
-----------------------------------------------------
Last Update Date | 08/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 YORK RD STE B1
-----------------------------------------------------
City | JENKINTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19046-2871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-405-2173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 YORK RD STE B1
-----------------------------------------------------
City | JENKINTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19046-2871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-405-2173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. TOMIKA MCFADDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-405-2173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | 103064470002
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------