MEDICARE: ONE DAY AT A TIME, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	104100000X	Social Worker
4	172V00000X	Community Health Worker
5	251K00000X	Public Health or Welfare Agency
6	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1346694726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE DAY AT A TIME, INC.

Provider Business Mailing Address
First Line	:	2532 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-4013
Country	:	US
Telephone Number	:	215-226-0485
Fax Number	:	215-226-7869

Provider Business Practice Location Address
First Line	:	2432 W LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-3236
Country	:	US
Telephone Number	:	215-227-0485
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MEL WELLS
Credential	:
Telephone Number	:	215-226-7860

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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