Healthcare Provider Details

I. General information

NPI: 1326109836
Provider Name (Legal Business Name): CHILDREN'S CRISIS TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 N DELAWARE AVE SUITE 600
PHILADELPHIA PA
19125-4330
US

IV. Provider business mailing address

1080 N DELAWARE AVE SUITE 600
PHILADELPHIA PA
19125-4330
US

V. Phone/Fax

Practice location:
  • Phone: 215-496-0707
  • Fax: 215-496-0742
Mailing address:
  • Phone: 215-496-0707
  • Fax: 215-496-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number139510
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number121850
License Number StatePA

VIII. Authorized Official

Name: MR. ANTONIO VALDES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 215-496-0707