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6701 N Broad St Philadelphia PA 19126-2837 | |
| (215) 276-3922 | |
| (215) 924-4485 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6701 N Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Takisa S Gallman (VP ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 2152763922 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6711 Old York Rd Philadelphia PA 19126-2841 Ph: (215) 276-3922 | 6701 N Broad St Philadelphia PA 19126-2837 Ph: (215) 276-3922 |
| NPI Number | 1063464055 |
|---|---|
| Provider Enumeration Date | 05/17/2006 |
| Last Update Date | 01/12/2021 |
| Certification Date | 01/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063464055 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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