1699067256 NPI number — TO OUR CHILDREN'S FUTURE WITH HEALTH INC.

Table of content: (NPI 1699067256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699067256 NPI number — TO OUR CHILDREN'S FUTURE WITH HEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TO OUR CHILDREN'S FUTURE WITH HEALTH INC.
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:
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:
1699067256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1914 NORTH 63RD STREET
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:
19151-3318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-879-7740
Provider Business Mailing Address Fax Number:
215-879-7743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4035 WEST POWELTON AVENUE
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:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-222-2161
Provider Business Practice Location Address Fax Number:
215-474-0451
Provider Enumeration Date:
05/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER-DRAIN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
215-915-1706

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW015104 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD039729-L , 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: 00105466000009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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