Provider Demographics
NPI:1538412010
Name:POSITIVE EFFECT OUTREACH MINISTRY, INC.
Entity type:Organization
Organization Name:POSITIVE EFFECT OUTREACH MINISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-840-2327
Mailing Address - Street 1:5000 WOODBINE AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2535
Mailing Address - Country:US
Mailing Address - Phone:215-840-2327
Mailing Address - Fax:
Practice Address - Street 1:8711 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1115
Practice Address - Country:US
Practice Address - Phone:215-840-2327
Practice Address - Fax:610-449-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016756100001Medicaid