MEDICARE: PETTAWAY PURSUIT FOUNDATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	251E00000X	Home Health Agency
4	374J00000X	Doula

General Provider Information

NPI Number	:	1154857589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETTAWAY PURSUIT FOUNDATION

Provider Business Mailing Address
First Line	:	624 MASON AVE
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-2430
Country	:	US
Telephone Number	:	610-553-5481
Fax Number	:	610-553-5482

Provider Business Practice Location Address
First Line	:	7408 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2006
Country	:	US
Telephone Number	:	610-553-5481
Fax Number	:	610-553-5482

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	THERESA PETTAWAY
Credential	:
Telephone Number	:	610-553-5481

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	06/25/2025

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Directions to “PETTAWAY PURSUIT FOUNDATION ” Practice Location

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