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General NPI Number Information
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NPI Number | 1760610117
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Entity Type | Organization
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Legal Business Name | THE KING'S HOUSE
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 3509 N AMERICAN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5701
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Country | US
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Telephone | 267-639-5185
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Fax | 267-639-5189
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Provider Business Mailing Address
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Address Line | 3509 N AMERICAN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5701
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Country | US
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Telephone | 267-639-5185
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Fax | 267-639-5189
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. PAUL AZZINARO
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Credential |
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Telephone | 267-639-5185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 807409
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License Number State | PA
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