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General NPI Number Information
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NPI Number | 1225261084
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Entity Type | Organization
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Legal Business Name | ST. JOHN'S COMMUNITY SERVICES
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 520 N COLUMBUS BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4226
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Country | US
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Telephone | 267-238-9540
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Fax | 215-451-5073
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Provider Business Mailing Address
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Address Line | 520 N COLUMBUS BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4226
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Country | US
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Telephone | 267-238-9540
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Fax | 215-451-5073
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Authorized Official
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Title or Position | STATE DIRECTOR
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Name | MS. NICOLE A BUCKLEY
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Credential |
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Telephone | 267-238-9540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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