1518056159 NPI number — WIVES SELF HELP FOUNDATION, INC

Table of content: (NPI 1518056159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518056159 NPI number — WIVES SELF HELP FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIVES SELF HELP FOUNDATION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COUNSELING AND THERAPY ASSOC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518056159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8001 ROOSEVELT BLVD
Provider Second Line Business Mailing Address:
205-207
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19152-3038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-332-1914
Provider Business Mailing Address Fax Number:
215-332-1873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8001 ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
205-207
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152-3038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-332-1914
Provider Business Practice Location Address Fax Number:
215-332-1873
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAHL
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
215-332-1914

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  130640 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TA0700X , with the licence number: 130640 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TB0200X , with the licence number: 130640 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC1900X , with the licence number: 130640 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC2200X , with the licence number: 130640 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: 130640 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 130640 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: WI428641 . This is a "BC/BS ID 2" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5356319 . This is a "AETNA ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0727023000 . This is a "MAGELLAN ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 514223 . This is a "BC/BS ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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