| Awjw1 Llc | |
|
100 S Broad St Ste 2230 Philadelphia PA 19110-1021 | |
| (484) 965-9529 | |
| Not Available |
| Full Name | Awjw1 Llc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 100 S Broad St Ste 2230, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Steve Kushner (CHIEF CLINICAL OFFICER) |
| Authorized Official Contact | 4849659529 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awjw1 Llc 1000 Germantown Pike Ste E1 Plymouth Meeting PA 19462-2485 Ph: (484) 965-9529 | Awjw1 Llc 100 S Broad St Ste 2230 Philadelphia PA 19110-1021 Ph: (484) 965-9529 |
| NPI Number | 1215796115 |
|---|---|
| Provider Enumeration Date | 03/14/2024 |
| Last Update Date | 03/14/2024 |
| Certification Date | 03/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215796115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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