Organization
COSMOLOGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLYDE SANDERS (OWNER)
(215) 771-1819
Entity
Organization
Contact information
Practice address
5746 N 19TH ST, PHILADELPHIA, PA 19141-1204
(215) 771-1819
(215) 277-7227
Mailing address
5746 N 19TH ST, PHILADELPHIA, PA 19141-1204
(215) 771-1819
(215) 277-7227
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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