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General NPI Number Information
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NPI Number | 1245640234
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Entity Type | Organization
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Legal Business Name | GWEN'S GIRLS, INC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 744 W COMMONS 3RD FLOOR
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City | PITTSBURGH
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State | PA
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Zip | 15212
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Country | US
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Telephone | 412-731-7670
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Fax |
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Provider Business Mailing Address
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Address Line | 744 W COMMONS 3RD FLOOR
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City | PITTSBURGH
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State | PA
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Zip | 15212
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Country | US
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Telephone | 412-731-7670
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LYNN KNEZEVICH
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Credential |
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Telephone | 412-731-7670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 104100000X
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License Number State | PA
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