# EASTER SEALS OF SOUTHEASTERN PENNSYLVANIA

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

## Provider details

- **NPI number:** 1962626127
- **Authorized official:** MS. IVY C LEWIS (DIR OF FINANCE CFO)
- **Authorized official phone:** (215) 879-3542

## Contact information

- **Practice address:** 3975 CONSHOHOCKEN AVE, PHILADELPHIA, PA 19131-5426
- **Practice address phone:** (215) 879-1000
- **Practice address fax:** (215) 879-8424
- **Mailing address:** 3975 CONSHOHOCKEN AVE, PHILADELPHIA, PA 19131-5426
- **Mailing address phone:** (215) 879-1000
- **Mailing address fax:** (215) 879-8424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 03/24/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1000005500020 | — | PA |