| Bethanna | |
|
1212 Wood St Philadelphia PA 19107-1113 | |
| (215) 568-2435 | |
| (215) 564-4740 |
| Full Name | Bethanna |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1212 Wood St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Ronald L Fritch (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2153556500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bethanna 1030 2nd Street Pike Southampton PA 18966-3955 Ph: (215) 355-6500 | Bethanna 1212 Wood St Philadelphia PA 19107-1113 Ph: (215) 568-2435 |
| NPI Number | 1710104252 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710104252 | NPI | - | NPPES |
| 1007513410005 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 100910 (Pennsylvania) | Primary |
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