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General NPI Number Information
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NPI Number | 1417327305
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Entity Type | Organization
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Legal Business Name | BARBARA GILLIAM
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 6243 LAWNDALE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5705
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Country | US
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Telephone | 215-847-7061
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Fax | 215-722-2354
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Provider Business Mailing Address
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Address Line | 6243 LAWNDALE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5705
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Country | US
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Telephone | 215-847-7061
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Fax | 215-722-2354
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Authorized Official
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Title or Position | OWNER
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Name | BARBARA GILLIAM
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Credential |
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Telephone | 215-847-7061
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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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