Healthcare Provider Details

I. General information

NPI: 1407179260
Provider Name (Legal Business Name): WEST PHILA MN HLTH CONSORTIUM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 CHESTNUT ST
PHILADELPHIA PA
19139-3205
US

IV. Provider business mailing address

3801 MARKET ST SUITE 201
PHILADELPHIA PA
19104-3153
US

V. Phone/Fax

Practice location:
  • Phone: 215-748-8400
  • Fax: 215-748-8877
Mailing address:
  • Phone: 215-596-8100
  • Fax: 215-382-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA A BOOKER
Title or Position: ACTING CEO/PERSONNEL DIRECTOR
Credential:
Phone: 215-596-8100