Provider Demographics
NPI:1447688734
Name:JUDITH CREED HOMES FOR ADULT INDEPENDENCE, INC.
Entity type:Organization
Organization Name:JUDITH CREED HOMES FOR ADULT INDEPENDENCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:610-922-2480
Mailing Address - Street 1:274 S BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2105
Mailing Address - Country:US
Mailing Address - Phone:610-922-2480
Mailing Address - Fax:610-520-4705
Practice Address - Street 1:274 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2105
Practice Address - Country:US
Practice Address - Phone:610-922-2480
Practice Address - Fax:610-520-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA180590251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100000872Medicaid