Healthcare Provider Details

I. General information

NPI: 1245676634
Provider Name (Legal Business Name): WES HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 N BROAD ST
PHILADELPHIA PA
19132-4013
US

IV. Provider business mailing address

1315 WINDRIM AVE
PHILADELPHIA PA
19141-2710
US

V. Phone/Fax

Practice location:
  • Phone: 215-599-2844
  • Fax:
Mailing address:
  • Phone: 215-455-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS COOK
Title or Position: CEO
Credential:
Phone: 267-256-5205