# CITYLIFE-PA, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285010801
- **Authorized official:** WILLIAM BRADLEY ROUSE (EVP)
- **Authorized official phone:** (615) 708-4487

## Contact information

- **Practice address:** 3945 CHESTNUT ST, 2ND FLOOR, PHILADELPHIA, PA 19104-3621
- **Practice address phone:** (267) 819-1800
- **Mailing address:** 2020 21ST AVE S, SUITE 202, NASHVILLE, TN 37212-4354
- **Mailing address phone:** (615) 708-4487

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/05/2015
- **Last updated:** 08/05/2015