Provider Demographics
NPI:1114279544
Name:AMUDIPES SERVICE COORDINATOR AGENCY
Entity type:Organization
Organization Name:AMUDIPES SERVICE COORDINATOR AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-793-0433
Mailing Address - Street 1:90 NORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2802
Mailing Address - Country:US
Mailing Address - Phone:215-793-0433
Mailing Address - Fax:267-295-2644
Practice Address - Street 1:90 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2802
Practice Address - Country:US
Practice Address - Phone:215-793-0433
Practice Address - Fax:267-295-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management