Provider Demographics
NPI:1447670708
Name:CHILDREN'S INTEGRATED CENTER FOR SUCCESS
Entity type:Organization
Organization Name:CHILDREN'S INTEGRATED CENTER FOR SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:PROF
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,CRNP, FNP-C
Authorized Official - Phone:610-770-1800
Mailing Address - Street 1:1247 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6298
Mailing Address - Country:US
Mailing Address - Phone:610-770-1800
Mailing Address - Fax:
Practice Address - Street 1:1247 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6298
Practice Address - Country:US
Practice Address - Phone:610-770-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty