Healthcare Provider Details

I. General information

NPI: 1013077551
Provider Name (Legal Business Name): PMHCC CTT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date: 06/03/2008
Reactivation Date: 06/17/2008

III. Provider practice location address

520 N COLUMBUS BLVD 4D
PHILADELPHIA PA
19123-4226
US

IV. Provider business mailing address

520 N COLUMBUS BLVD 4D
PHILADELPHIA PA
19123-4226
US

V. Phone/Fax

Practice location:
  • Phone: 215-923-8042
  • Fax: 215-923-8064
Mailing address:
  • Phone: 215-923-8042
  • Fax: 215-923-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number251203882
License Number StatePA

VIII. Authorized Official

Name: MR. KENNETH J CULNAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 215-923-8042