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NPI Code Detail

MEDICARE: COMMUNITY COUNCIL FOR MH/MR, INC.

MEDICARE: COMMUNITY COUNCIL FOR MH/MR, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2261QC1500XCommunity Health Clinic/Center121630PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1600003557OTHERPAMAGELLAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649377003
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY COUNCIL FOR MH/MR, INC.
Provider Business Mailing Address
First Line : 4900 WYALUSING AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19131-5127
Country : US
Telephone Number : 215-921-3713
Fax Number : 215-827-5276
Provider Business Practice Location Address
First Line : 4900 WYALUSING AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19131-5127
Country : US
Telephone Number : 215-473-7033
Fax Number : 215-473-5405
Authorized Official
Title or Position : CEO
Name : MR. ALEX MOORE
Credential :
Telephone Number : 215-473-7033
Provider Enumeration Date : 09/20/2006
Last Update Date : 05/11/2026

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