Provider Demographics
NPI:1861131427
Name:COLEMAN, CARLA R
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 ROSALIE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1223
Mailing Address - Country:US
Mailing Address - Phone:267-902-9622
Mailing Address - Fax:
Practice Address - Street 1:615 ROSALIE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1223
Practice Address - Country:US
Practice Address - Phone:267-902-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251B00000X, 251G00000X, 374U00000X
PA61563601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No374U00000XNursing Service Related ProvidersHome Health Aide