Organization
ACTIVE COMMUNITY SUPPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES K NYAGA DR (EXECUTIVE DIRECTOR)
(484) 350-0075
Entity
Organization
Contact information
Practice address
3505 W MORELAND RD, WILLOW GROVE, PA 19090-3831
(484) 350-0075
Mailing address
3505 W MORELAND RD, WILLOW GROVE, PA 19090-3831
(484) 350-0075
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/18/2019
Last updated
11/18/2019
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