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General NPI Number Information
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NPI Number | 1306354212
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Entity Type | Organization
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Legal Business Name | NEW LIFE FOUNDATION OF PA
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 6701 OGONTZ AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19126-2639
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Country | US
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Telephone | 215-298-9047
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Fax | 215-298-9049
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Provider Business Mailing Address
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Address Line | 6701 OGONTZ AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19126-2639
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Country | US
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Telephone | 215-298-9047
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANNETTE FREY
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Credential | RN
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Telephone | 215-298-9047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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