Healthcare Provider Details

I. General information

NPI: 1720072366
Provider Name (Legal Business Name): RESOURCES FOR HUMAN DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 KELLY DR 1ST FLOOR
PHILADELPHIA PA
19129-1760
US

IV. Provider business mailing address

4700 WISSAHICKON AVE SUITE 118
PHILADELPHIA PA
19144-4248
US

V. Phone/Fax

Practice location:
  • Phone: 215-843-2580
  • Fax: 215-843-4086
Mailing address:
  • Phone: 215-438-4779
  • Fax: 215-298-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BOB FISHMAN
Title or Position: CHIEF EXECUTIVE OFFICIER
Credential:
Phone: 215-951-0300