Healthcare Provider Details

I. General information

NPI: 1073512331
Provider Name (Legal Business Name): BELMONT CENTER FOR COMPRHENSIVE TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MONUMENT RD
PHILA PA
19131-1625
US

IV. Provider business mailing address

4200 MONUMENT RD
PHILA PA
19131-1625
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-6611
  • Fax: 215-457-4304
Mailing address:
  • Phone: 215-456-6611
  • Fax: 215-457-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number117160
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number117160
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number121960
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number177920
License Number StatePA

VIII. Authorized Official

Name: MR. SAMUEL RUSSO
Title or Position: CORP. DIRECTOR OF FINANCE
Credential:
Phone: 215-456-6611