MEDICARE: AVENUES OF HOPE

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	251S00000X	Community/Behavioral Health Agency	6461881	PA

General Provider Information

NPI Number	:	1194267914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENUES OF HOPE

Provider Business Mailing Address
First Line	:	4949 LIBERTY LN
Second Line	:	SUITE 210
City	:	ALLENTOWN
State	:	PA
Zip	:	18106-9014
Country	:	US
Telephone Number	:	484-347-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 LIBERTY LN
Second Line	:	SUITE 210
City	:	ALLENTOWN
State	:	PA
Zip	:	18106-9014
Country	:	US
Telephone Number	:	484-347-8100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. NELLY KABIRU
Credential	:
Telephone Number	:	484-347-8100

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	11/10/2016

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Directions to “AVENUES OF HOPE ” Practice Location

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