Organization
EMBOLDEN COMMUNITY ALLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINDI MUCHOKI (CEO)
(267) 810-4866
Entity
Organization
Contact information
Practice address
4000 GYPSY LN UNIT 204, PHILADELPHIA, PA 19129-5405
(267) 810-4866
Mailing address
4000 GYPSY LN UNIT 204, PHILADELPHIA, PA 19129-5405
(267) 810-4866
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103643212
—
PA
Enumeration date
12/02/2019
Last updated
12/02/2019
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