MEDICARE: COMM FOR DIGNITY & FAIRNESS FOR THE HOMELESS HOUSING DEVELOPMENT

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
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1336896885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMM FOR DIGNITY & FAIRNESS FOR THE HOMELESS HOUSING DEVELOPMENT

Provider Business Mailing Address
First Line	:	5227R GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2301
Country	:	US
Telephone Number	:	215-713-0960
Fax Number	:

Provider Business Practice Location Address
First Line	:	5227R GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-2301
Country	:	US
Telephone Number	:	215-713-0960
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JACK BROWN
Credential	:
Telephone Number	:	718-791-3460

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/04/2022

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