| Community Council For Mh/mr | |
|
4900 Wyalusing Ave Philadelphia PA 19131-5127 | |
| (215) 473-7033 | |
| (215) 933-6926 |
| Full Name | Community Council For Mh/mr |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4900 Wyalusing Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | James Paige (CHIEF INFORMATION OFFICER) |
| Authorized Official Contact | 2154737033 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Council For Mh/mr 4900 Wyalusing Ave Philadelphia PA 19131-5127 Ph: (215) 473-7033 | Community Council For Mh/mr 4900 Wyalusing Ave Philadelphia PA 19131-5127 Ph: (215) 473-7033 |
| NPI Number | 1104008911 |
|---|---|
| Provider Enumeration Date | 12/04/2007 |
| Last Update Date | 03/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104008911 | NPI | - | NPPES |
| 1000049601019 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 132640 (Pennsylvania) | Primary |
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