Provider Demographics
NPI:1063895571
Name:JAMES NATHANIEL
Entity type:Organization
Organization Name:JAMES NATHANIEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:NATHANIEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:267-334-9523
Mailing Address - Street 1:9 W. PHIL-ELLENA STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119
Mailing Address - Country:US
Mailing Address - Phone:267-334-9523
Mailing Address - Fax:
Practice Address - Street 1:9 W PHIL ELLENA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2725
Practice Address - Country:US
Practice Address - Phone:267-334-9523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness