=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609347426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABLE2CONNECT INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2018
-----------------------------------------------------
Last Update Date | 12/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7920 FOX RUN LN
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19111-2653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-305-9777
-----------------------------------------------------
Fax | 215-305-9804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7920 FOX RUN LN
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19111-2653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-305-9777
-----------------------------------------------------
Fax | 215-305-9804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | NATHAN OSBORNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-906-0522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------