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General NPI Number Information
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NPI Number | 1811584022
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Entity Type | Organization
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Legal Business Name | FATHERSHIP FOUNDATION
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 6504 ELMWOOD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-2817
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Country | US
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Telephone | 267-232-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 6504 ELMWOOD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-2817
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Country | US
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Telephone | 267-232-8383
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JONATHAN WILSON JR.
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Credential | DR.
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Telephone | 267-232-8383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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