MEDICARE: POSITIVE EFFECT OUTREACH MINISTRY, 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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538412010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE EFFECT OUTREACH MINISTRY, INC.

Provider Business Mailing Address
First Line	:	5000 WOODBINE AVE
Second Line	:	SUITE 312
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2535
Country	:	US
Telephone Number	:	215-840-2327
Fax Number	:

Provider Business Practice Location Address
First Line	:	8711 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-1115
Country	:	US
Telephone Number	:	215-840-2327
Fax Number	:	610-449-5272

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ELIZABETH ANN MINOR
Credential	:
Telephone Number	:	215-840-2327

Provider Enumeration Date	:	10/20/2012
Last Update Date	:	10/20/2012

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