| Transition Phase Iii | |
|
3900 City Ave Madison Bldg Suite 1207 Philadelphia PA 19131-2908 | |
| (215) 878-3052 | |
| (215) 878-3532 |
| Full Name | Transition Phase Iii |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3900 City Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Jo Benait (CEO GROUP ADMINISTRATOR) |
| Authorized Official Contact | 2158783052 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Transition Phase Iii 3900 City Avenue Madison Bldg Suite 1207 Philadelphia PA 19131-0000 Ph: (215) 878-3052 | Transition Phase Iii 3900 City Ave Madison Bldg Suite 1207 Philadelphia PA 19131-2908 Ph: (215) 878-3052 |
| NPI Number | 1720288913 |
|---|---|
| Provider Enumeration Date | 07/25/2007 |
| Last Update Date | 04/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720288913 | NPI | - | NPPES |
| 1019569460001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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