Provider Demographics
NPI:1962181206
Name:M AND A GROUP HOMES
Entity type:Organization
Organization Name:M AND A GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODURO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:484-378-2424
Mailing Address - Street 1:1 INTERNATIONAL PLZ STE 550
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19113-1528
Mailing Address - Country:US
Mailing Address - Phone:484-378-2424
Mailing Address - Fax:
Practice Address - Street 1:9504 RISING SUN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3008
Practice Address - Country:US
Practice Address - Phone:484-378-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health