1629258157 NPI number — JEWISH FAMILY & CHILDRENS SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629258157 NPI number — JEWISH FAMILY & CHILDRENS SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH FAMILY & CHILDRENS SERVICE
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:
Provider Other Organization Name Type Code:
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:
1629258157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 ARCH ST FL 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19103-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-496-9700
Provider Business Mailing Address Fax Number:
215-496-6622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 CONSHOHOCKEN AVE STE 123
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:
19131-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-878-2336
Provider Business Practice Location Address Fax Number:
215-878-2379
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WYLAND
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
215-496-9700

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1041C0700X , 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: 1000008810009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000008810019 . This is a "DPW PDA WAIVER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000008810025 . This is a "DEPT OF PUBLIC WELFARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com