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1919 Castor Ave Philadelphia PA 19134 | |
| (215) 728-4600 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1919 Castor Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Karen L Graves (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 2153160794 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1919 Cottman Ave Philadelphia PA 19111-3816 Ph: (215) 728-4600 | 1919 Castor Ave Philadelphia PA 19134 Ph: (215) 728-4600 |
| NPI Number | 1154485019 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 12/15/2021 |
| Certification Date | 12/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154485019 | NPI | - | NPPES |
| 1000015840057 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 900304 (Pennsylvania) | Primary |
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