| Costar- Preston Ave | |
|
33 N Preston St Philadelphia PA 19104-2258 | |
| (215) 222-0205 | |
| (215) 848-5318 |
| Full Name | Costar- Preston Ave |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 33 N Preston St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Brian Matthew Rhodes (CEO) |
| Authorized Official Contact | 2159510300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Costar- Preston Ave 4700 Wissahickon Ave Suite 126 Philadelphia PA 19144-4248 Ph: (215) 951-0300 | Costar- Preston Ave 33 N Preston St Philadelphia PA 19104-2258 Ph: (215) 222-0205 |
| NPI Number | 1427435213 |
|---|---|
| Provider Enumeration Date | 04/30/2015 |
| Last Update Date | 06/20/2024 |
| Certification Date | 06/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427435213 | NPI | - | NPPES |
| 100001708-0626 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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