1659792372 NPI number — BYFAITHENTERNAL HEALTH CARE

Table of content: (NPI 1659792372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659792372 NPI number — BYFAITHENTERNAL HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYFAITHENTERNAL HEALTH CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659792372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2131 GRANITE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19124-2207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-571-5121
Provider Business Mailing Address Fax Number:
215-533-2314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2131 GRANITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-571-5121
Provider Business Practice Location Address Fax Number:
215-533-2314
Provider Enumeration Date:
12/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MOSLEY
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
FLORENCE
Authorized Official Title or Position:
PRESIDENT/OWNER REGISTERED NURSE
Authorized Official Telephone Number:
215-571-5121

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  RN531355 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4227275 . This is a "ENTITY NUMBER FOR BYFAITHENTERNAL HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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