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General NPI Number Information
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NPI Number | 1205757580
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Entity Type | Organization
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Legal Business Name |
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 406 N 65TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19151-4003
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Country | US
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Telephone | 215-791-8430
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Fax | 888-493-3438
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Provider Business Mailing Address
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Address Line | 406 N 65TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19151-4003
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Country | US
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Telephone | 215-791-8430
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Fax | 888-493-3438
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | MISS KHALIAH MOODY
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Credential | MS, LBS, BCBA
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Telephone | 215-791-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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