Organization
A CHANGE FROM WITHIN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TANYIKIA SHARAY ALSTON M.S (PARTNER)
(215) 806-9953
Entity
Organization
Contact information
Practice address
1641 WIDENER PL, PHILADELPHIA, PA 19141-1815
(215) 806-9953
Mailing address
2991 W SCHOOL HOUSE LN APT OE14, PHILADELPHIA, PA 19144-5339
(215) 806-9953
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/25/2017
Last updated
07/25/2017
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