1841319332 NPI number — WEST PHILA COMMUNITY MENTAL HEALTH CONSORTIUM, INC.

Table of content: (NPI 1841319332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841319332 NPI number — WEST PHILA COMMUNITY MENTAL HEALTH CONSORTIUM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST PHILA COMMUNITY MENTAL HEALTH CONSORTIUM, 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:
Provider Other Organization Name Type Code:
6
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:
1841319332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3751 ISLAND AVE STE 303
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:
19153-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-596-8100
Provider Business Mailing Address Fax Number:
215-382-0511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 CHESTNUT ST
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:
19139-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-596-8100
Provider Business Practice Location Address Fax Number:
215-382-4405
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DITROLIO
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE MANAGEMEN
Authorized Official Telephone Number:
215-596-8100

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 128620 , 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: 1007155230080 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007155230113 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007155230120 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com