| Interim House West | |
|
4108 Parkside Avenue Philadelphia PA 19102 | |
| (215) 871-0300 | |
| (215) 477-0244 |
| Full Name | Interim House West |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4108 Parkside Avenue, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Richard J Cohen (PRESIDENT) |
| Authorized Official Contact | 2159852501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Interim House West 1500 Market St Fl East17 Philadelphia PA 19102-2100 Ph: (215) 985-2500 | Interim House West 4108 Parkside Avenue Philadelphia PA 19102 Ph: (215) 871-0300 |
| NPI Number | 1932245099 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 12/18/2019 |
| Certification Date | 12/18/2019 |
| Medicare PECOS PAC ID | 1850307406 |
|---|---|
| Medicare Enrollment ID | O20200213002103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932245099 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 807285 (Pennsylvania) | Primary |
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