Healthcare Provider Details

I. General information

NPI: 1033595921
Provider Name (Legal Business Name): BECTON COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5244 LEBANON AVE
PHILADELPHIA PA
19131-2307
US

IV. Provider business mailing address

1022 N 46TH ST
PHILADELPHIA PA
19131-4614
US

V. Phone/Fax

Practice location:
  • Phone: 267-934-0557
  • Fax:
Mailing address:
  • Phone: 267-934-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLIE N BECTON
Title or Position: CHIEF OPERATING OFFICER
Credential: EDD LPC
Phone: 267-934-0557