MEDICARE: WOMEN'S CHRISTIAN ALLIANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1033463732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN'S CHRISTIAN ALLIANCE

Provider Business Mailing Address
First Line	:	1722 CECIL B MOORE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 CECIL B MOORE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3231
Country	:	US
Telephone Number	:	215-236-9808
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF PROGRAMS
Name	:	ANN MYERS
Credential	:
Telephone Number	:	215-236-9808

Provider Enumeration Date	:	11/01/2012
Last Update Date	:	11/01/2012

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