Provider Demographics
NPI:1154857589
Name:PETTAWAY PURSUIT FOUNDATION
Entity type:Organization
Organization Name:PETTAWAY PURSUIT FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-553-5481
Mailing Address - Street 1:624 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2430
Mailing Address - Country:US
Mailing Address - Phone:610-553-5481
Mailing Address - Fax:610-553-5482
Practice Address - Street 1:7408 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2006
Practice Address - Country:US
Practice Address - Phone:610-553-5481
Practice Address - Fax:610-553-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251E00000XAgenciesHome Health