OrganizationActive
Living Independantly for Elders
NPI 1730403445 · Preferred Provider Organization · Phila, PA
Provider details
- NPI number
- 1730403445
- Entity type
- Organization
- Primary specialty
- Preferred Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Mary Austin, Cno(215) 746-6893
- License
- SP010396 (PA)
Specialties & taxonomies
Managed Care Organizations
Practice location
4508 Chestnut St
Phila, PA 19139-3608
Phone: (215) 746-6893
Approximate (ZIP-level) locationGet directions
Mailing address
4508 Chestnut St
Phila, PA 19139-3608
Registry dates
- Enumerated
- 2010-03-24
- Last updated
- 2010-03-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.