Healthcare Provider Details

I. General information

NPI: 1225385511
Provider Name (Legal Business Name): HEALTH SERVICE INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CAYUGA ST
PHILA PA
19140-1905
US

IV. Provider business mailing address

1501 W CAYUGA ST
PHILA PA
19140-1905
US

V. Phone/Fax

Practice location:
  • Phone: 215-669-6325
  • Fax:
Mailing address:
  • Phone: 215-669-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: VONCEL R HARRIGAN
Title or Position: OWNER/VICE PRESIDENT
Credential:
Phone: 215-669-6325