MEDICARE: OPPORTUNITY ADKINSON PROJECT, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QE0002X	Emergency Care Clinic/Center
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1558930909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPPORTUNITY ADKINSON PROJECT, INC.

Provider Business Mailing Address
First Line	:	633 E ALLEGHENY AVE # 19134
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-2330
Country	:	US
Telephone Number	:	267-601-4175
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-2330
Country	:	US
Telephone Number	:	267-601-4175
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	JOHNNA COLES
Credential	:
Telephone Number	:	267-610-4175

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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