EMBOLDEN COMMUNITY ALLIES (NPI# 1104463736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104463736 |
Entity Type | Organization |
Organization Name | EMBOLDEN COMMUNITY ALLIES |
Practice Address |
4000 Gypsy Ln Unit 204 Philadelphia PA 19129-5405 |
Practice Telephone | 2678104866 |
Mailing Telephone | 2678104866 |
Enumeration Date | 2019-12-02 |
Last Update Date | 2019-12-02 |
Authorized Official Name | CINDI MUCHOKI (CEO) |
Authorized Official Telephone | 2678104866 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
PA | 103643212 | 05 |
Street Address |
4000 GYPSY LN UNIT 204 |
City | PHILADELPHIA |
State | PA |
Zip Code | 19129-5405 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982243754 | Margaret Brown | Social Worker | Sherman Mills 3502 Scott's Lane, Building 16, Philadelphia, PA 19129 | 2019-12-27 |
1518325760 | Care365 Inc | Case Management | 3507 Scotts Ln, Ste. 1923, Philadelphia, PA 19129 | 2016-02-03 |
1144698408 | Raymond C Nwaneri | Nurse Practitioner | 3301 Scotts Lane, Haven Behavioral Hospital, Philadelphia, PA 19129 | 2015-09-03 |
1659748432 | Donna S. Wolf | Social Worker | 3302 Tilden Street, Philadelphia, PA 19129 | 2015-08-27 |
1891066619 | Melissa Sayer | Advanced Practice Midwife | 2450 W. Hunting Park Ave, Temple University Health System, Philadelphia, PA 19129 | 2012-01-25 |
1154604007 | Keystone Psychological Associates | Clinic/Center | 3502 Scotts Lane, Building 1 Suite 114, Philadelphia, PA 19129 | 2011-09-27 |
1174754618 | Clarence B Iszard Jr. | Counselor | 3246 North Bailey Street, Philadelphia, PA 19129 | 2009-07-31 |
1487816708 | St.chris Care At Northeast Pediatrics, LLC | Pediatrics | One Falls Center, 3300 Henry Avenue, 4th Floor, Philadelphia, PA 19129 | 2008-06-27 |
1740400845 | Sharon L. Young | Psychologist | 3205 Defense Terrace, Abbottsford Family Practice & Counseling, Philadelphia, PA 19129 | 2007-04-30 |
1043355621 | Donald Herman Silverman | Dentist | 3405 Warden Drive, Philadelphia, PA 19129 | 2007-02-21 |
Find all providers in zip 19129 |
Taxonomy Code | 320600000X |
Grouping | Residential Treatment Facilities |
Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518470624 | Cdig Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1714 Danforth St, Philadelphia, PA 19152-1802 | 2017-11-10 |
1699285676 | Antonio Romero | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1045 N Leithgow St, Philadelphia, PA 19123-1420 | 2017-10-04 |
1578007795 | Rhonda Hill-sharif | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2932 N Taylor St, Philadelphia, PA 19132-1911 | 2016-12-06 |
1588039960 | Holcomb Associates, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4000 Presidential Blvd Apt 1101, Philadelphia, PA 19131-1720 | 2015-12-10 |
1205213832 | Serene Services Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1144 N 4th St, Philadelphia, PA 19123-1503 | 2015-05-04 |
1982931440 | Vernon Care Living Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 729 E Vernon Rd, Philadelphia, PA 19119-1502 | 2009-11-04 |
1578715959 | Transion Stage Three | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5602 Harley Dr Apt 2c, Philadelphia, PA 19143-6264 | 2008-10-16 |
1760517205 | Eman Community Living Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 820 E Vernon Rd Fl 2, Philadelphia, PA 19119-1519 | 2007-02-23 |
1073882296 | Northeast Community Center for Mh/mr | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4641 Roosevelt Blvd, Orleans Building, Philadelphia, PA 19124-2343 | 2011-12-16 |
1093995243 | Resources for Human Development | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4700 Wissahickon Ave, Philadelphia, PA 19144-4248 | 2007-11-05 |
Find all providers in PHILADELPHIA |
City | PHILADELPHIA |
Zip Code | 19129 |
Please comment or provide details below to improve the information on EMBOLDEN COMMUNITY ALLIES.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.