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General NPI Number Information
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NPI Number | 1306229695
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Entity Type | Organization
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Legal Business Name | PROACTIVE SUPPORT COORDINATION AGENCY LLC
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Dates
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Enumeration Date | 07/03/2015
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Last Update Date | 07/03/2015
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Provider Practice Location Address
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Address Line | 4949 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2669
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Country | US
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Telephone | 215-613-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 S 68TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19142-3321
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Country | US
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Telephone | 215-880-5076
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ABOUBAKAR SIDIKI SYLLA
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Credential |
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Telephone | 215-880-5076
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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 |
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License Number State |
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