Provider Demographics
NPI:1124493515
Name:FIRELY PEDIATRIC SERVICES INC.
Entity type:Organization
Organization Name:FIRELY PEDIATRIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEKSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-513-7455
Mailing Address - Street 1:428 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403
Mailing Address - Country:US
Mailing Address - Phone:215-513-7455
Mailing Address - Fax:215-513-3031
Practice Address - Street 1:364 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2212
Practice Address - Country:US
Practice Address - Phone:215-513-7455
Practice Address - Fax:215-513-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACER-00087127314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACER-0087127Medicaid