Organization
PERSONAL CARE HOME C&G
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE DAVIS M. A (MENTAL HEALTH COUNSELOR)
(267) 235-7138
Entity
Organization
Contact information
Practice address
6176 NEWTOWN AVE, PHILADELPHIA, PA 19111
(267) 235-7138
Mailing address
6176 NEWTOWN AVE, PHILADELPHIA, PA 19111-5928
(267) 235-7138
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
724086
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
724086
—
PA
Enumeration date
03/08/2017
Last updated
03/08/2017
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