Provider Demographics
NPI:1245912203
Name:PHILADELPHIA LANCER ALLIANCE
Entity type:Organization
Organization Name:PHILADELPHIA LANCER ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAWANZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAHUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-669-2154
Mailing Address - Street 1:512 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1705
Mailing Address - Country:US
Mailing Address - Phone:215-669-2154
Mailing Address - Fax:
Practice Address - Street 1:1235 65TH AVE APT B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-3608
Practice Address - Country:US
Practice Address - Phone:215-669-2154
Practice Address - Fax:215-521-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care