=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669728630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POTENTIAL DISCOVERIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2012
-----------------------------------------------------
Last Update Date | 07/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 N. YORK RD SUITE 220
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-477-6587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 349 N. YORK RD SUITE 220
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-477-6587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | MISS NAJAH BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-477-6587
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 1-09-5862
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 1-09-5862
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------