1528171790 NPI number — DR WARREN E SMITH COMMUNITY MENTAL HEALTH MENTAL RETARDATION & SUBSTAN

Table of content: (NPI 1528171790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528171790 NPI number — DR WARREN E SMITH COMMUNITY MENTAL HEALTH MENTAL RETARDATION & SUBSTAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR WARREN E SMITH COMMUNITY MENTAL HEALTH MENTAL RETARDATION & SUBSTAN
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:
DR WARREN E SMITH HEALTH CENTERS WES HEALTH CENTERS
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:
1528171790
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:
1315 WINDRIM AVENUE
Provider Second Line Business Mailing Address:
DR WARREN E SMITH HEALTH CENTERS
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19141-2710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-456-2611
Provider Business Mailing Address Fax Number:
215-456-2729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 WINDRIM AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19141-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-456-2611
Provider Business Practice Location Address Fax Number:
215-456-2729
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GLASS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
267-256-0636

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  185300 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0561531000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000028030027 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000028030029 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000028030045 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1317149 . This is a "MAGELLAN BEHAV HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3136579 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000028030022 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000028030047 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000028031004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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