MEDICARE: THE SALVATION ARMY

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700446655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SALVATION ARMY

Provider Business Mailing Address
First Line	:	4050 CONSHOHOCKEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2826
Country	:	US
Telephone Number	:	215-400-6097
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 CONSHOHOCKEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2826
Country	:	US
Telephone Number	:	215-400-6097
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY -LEGAL
Name	:	RICHARD D ALLEN
Credential	:
Telephone Number	:	845-620-7330

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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Directions to “THE SALVATION ARMY ” Practice Location

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