Healthcare Provider Details

I. General information

NPI: 1043304199
Provider Name (Legal Business Name): NORTHEAST COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 N 5TH ST 2ND FLOOR
PHILADELPHIA PA
19133-2800
US

IV. Provider business mailing address

2030 W TILGHMAN ST SUITE 105B
ALLENTOWN PA
18104-4354
US

V. Phone/Fax

Practice location:
  • Phone: 215-291-4357
  • Fax: 484-221-9136
Mailing address:
  • Phone: 484-221-9136
  • Fax: 484-221-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number105610
License Number StatePA

VIII. Authorized Official

Name: MELISSA CHLEBOWSKI
Title or Position: CEO
Credential:
Phone: 484-221-9136