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General NPI Number Information
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NPI Number | 1609399237
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Entity Type | Organization
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Legal Business Name | A CHANGE FROM WITHIN, LLC
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/25/2017
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Provider Practice Location Address
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Address Line | 1641 WIDENER PL
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City | PHILADELPHIA
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State | PA
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Zip | 19141-1815
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Country | US
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Telephone | 215-806-9953
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Fax |
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Provider Business Mailing Address
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Address Line | 2991 W SCHOOL HOUSE LN APT OE14
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City | PHILADELPHIA
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State | PA
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Zip | 19144-5339
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Country | US
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Telephone | 215-806-9953
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MISS TANYIKIA SHARAY ALSTON
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Credential | M.S
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Telephone | 215-806-9953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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