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General NPI Number Information
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NPI Number | 1982931440
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Entity Type | Organization
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Legal Business Name | VERNON CARE LIVING INC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 729 E VERNON RD
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1502
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Country | US
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Telephone | 215-758-7136
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Fax |
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Provider Business Mailing Address
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Address Line | 1435 BOGGS RD APARTMENT 1018
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City | DULUTH
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State | GA
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Zip | 30096-1201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | MISS GORMAH PINKY KOLLEH
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Credential |
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Telephone | 215-758-7136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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