Organization
LILLY OF THE VALLEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANICE JENKINS (CEO)
(267) 902-2343
Entity
Organization
Contact information
Practice address
5651 WOODCREST AVE, PHILADELPHIA, PA 19131-1303
(267) 902-2343
Mailing address
4061 FILBERT ST, PHILADELPHIA, PA 19104-2256
(215) 662-3094
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
01/16/2019
Last updated
01/16/2019
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