=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881899284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF PHILA TRUSTEE ACTING BY THE BRD OF DIR OF CITY TRUSTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2007
-----------------------------------------------------
Last Update Date | 04/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 840 WALNUT ST 15TH FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-928-3320
-----------------------------------------------------
Fax | 215-928-3434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 840 WALNUT ST 15TH FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-928-3320
-----------------------------------------------------
Fax | 215-928-3434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MRS. JERI MOGLE
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 215-928-3306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 284300000X
-----------------------------------------------------
Taxonomy Name | Special Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------