Healthcare Provider Details

I. General information

NPI: 1265795322
Provider Name (Legal Business Name): FINAL MILE BEHAVIORAL MANAGEMENT SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S 58TH ST
PHILADELPHIA PA
19143-5932
US

IV. Provider business mailing address

5070 PARKSIDE AVE STE 2103
PHILADELPHIA PA
19131-4747
US

V. Phone/Fax

Practice location:
  • Phone: 215-724-2218
  • Fax: 215-724-6924
Mailing address:
  • Phone: 215-778-7261
  • Fax: 267-200-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. QASIM RASHAD
Title or Position: ADMINISTRATOR
Credential:
Phone: 215-778-7261