MEDICARE: A & T 215 HOLDINGS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	177F00000X	Lodging Provider
2	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
3	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1356022834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & T 215 HOLDINGS LLC

Provider Business Mailing Address
First Line	:	1242 S 20TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4338
Country	:	US
Telephone Number	:	267-977-0121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1242 S 20TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4338
Country	:	US
Telephone Number	:	267-977-0121
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MISS ATIYA GROOMES
Credential	:
Telephone Number	:	267-977-0121

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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Directions to “A & T 215 HOLDINGS LLC ” Practice Location

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