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General NPI Number Information
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NPI Number | 1841558590
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Entity Type | Organization
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Legal Business Name | NELLACARE AMBULANCE SERVICE
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 5398 WYNNEFIELD AVE SUITE 403
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2344
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Country | US
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Telephone | 215-252-0169
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Fax |
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Provider Business Mailing Address
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Address Line | 5398 WYNNEFIELD AVE SUITE 403
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2344
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Country | US
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Telephone | 215-252-0169
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MISS DAVETTE L CAMPBELL
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Credential |
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Telephone | 212-252-0169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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