Healthcare Provider Details

I. General information

NPI: 1023517646
Provider Name (Legal Business Name): CROZER KEYSTONE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S OLD MIDDLETOWN RD
MEDIA PA
19063-5024
US

IV. Provider business mailing address

1308 KENWOOD RD
WILMINGTON DE
19805-1327
US

V. Phone/Fax

Practice location:
  • Phone: 610-619-9870
  • Fax: 610-619-9870
Mailing address:
  • Phone: 484-343-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY ELIZABETH MCBRIDE
Title or Position: MSW
Credential: M.ED
Phone: 484-343-5459