| Prise-op | |
|
4329 Griscom St Phila PA 19124-5021 | |
| (215) 731-2042 | |
| (267) 765-2380 |
| Full Name | Prise-op |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4329 Griscom St, Phila, Pennsylvania |
| Authorized Official Name and Position | Shante Pennington (BILLING COORDINATOR) |
| Authorized Official Contact | 2157312042 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prise-op 260 S Broad St 18th Floor Phila PA 19102-5021 Ph: (215) 731-2042 | Prise-op 4329 Griscom St Phila PA 19124-5021 Ph: (215) 731-2042 |
| NPI Number | 1699956854 |
|---|---|
| Provider Enumeration Date | 11/16/2007 |
| Last Update Date | 07/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699956854 | NPI | - | NPPES |
| 1000016640043 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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