=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235293168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSANNA MINISTRIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 W HUNTING PARK AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-221-4188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 38152
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-0152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-221-4188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. DESMOND MAUL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-221-4188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MFT000266
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------