Healthcare Provider Details

I. General information

NPI: 1629258157
Provider Name (Legal Business Name): JEWISH FAMILY & CHILDRENS SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 CONSHOHOCKEN AVE STE 123
PHILADELPHIA PA
19131-5536
US

IV. Provider business mailing address

2100 ARCH ST FL 5
PHILADELPHIA PA
19103-1300
US

V. Phone/Fax

Practice location:
  • Phone: 215-878-2336
  • Fax: 215-878-2379
Mailing address:
  • Phone: 215-496-9700
  • Fax: 215-496-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1041C0700X
License Number StatePA

VIII. Authorized Official

Name: MRS. SUSAN WYLAND
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 215-496-9700