MEDICARE: LA ABODE INC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1437721610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA ABODE INC

Provider Business Mailing Address
First Line	:	3819 HAMILTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3819 HAMILTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2315
Country	:	US
Telephone Number	:	215-778-7407
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEO TIBERINO
Credential	:
Telephone Number	:	215-778-7407

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	07/15/2021

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Directions to “LA ABODE INC ” Practice Location

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