MEDICARE: MY COMMUNITY MY WAY

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	251C00000X	Developmentally Disabled Services Day Training Agency	251C00000X	PA

General Provider Information

NPI Number	:	1922413186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY COMMUNITY MY WAY

Provider Business Mailing Address
First Line	:	1715 NORTH FELTON STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151
Country	:	US
Telephone Number	:	215-877-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 NORTH FELTON STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151
Country	:	US
Telephone Number	:	215-877-9224
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. BEVERLY MOORE
Credential	:
Telephone Number	:	215-877-9224

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/26/2014

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Directions to “MY COMMUNITY MY WAY ” Practice Location

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