MEDICARE: JAMES NATHANIEL

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1063895571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES NATHANIEL

Provider Business Mailing Address
First Line	:	9 W. PHIL-ELLENA STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119
Country	:	US
Telephone Number	:	267-334-9523
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 W PHIL ELLENA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2725
Country	:	US
Telephone Number	:	267-334-9523
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES L NATHANIEL JR.
Credential	:
Telephone Number	:	267-334-9523

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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