MEDICARE: TRANSCENDENCE SUPPORT SERVICES LIMITED LIABILITY COMPANY

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	104100000X	Social Worker		PA

General Provider Information

NPI Number	:	1811494537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSCENDENCE SUPPORT SERVICES LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	7451 RUSKIN RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2925
Country	:	US
Telephone Number	:	215-853-4886
Fax Number	:

Provider Business Practice Location Address
First Line	:	7451 RUSKIN RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2925
Country	:	US
Telephone Number	:	215-853-4886
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER/ OWNER
Name	:	NICOLE C MARTIN
Credential	:
Telephone Number	:	215-853-4886

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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