Healthcare Provider Details

I. General information

NPI: 1598798928
Provider Name (Legal Business Name): THE BEHAVIORAL WELLNESS CENTER AT GIRARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W GIRARD AVE
PHILADELPHIA PA
19122-4212
US

IV. Provider business mailing address

801 W GIRARD AVE
PHILADELPHIA PA
19122-4212
US

V. Phone/Fax

Practice location:
  • Phone: 215-787-2000
  • Fax: 215-787-2115
Mailing address:
  • Phone: 215-787-2000
  • Fax: 215-787-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MR. XAVIER BANCROFT
Title or Position: CEO/PRESIDENT
Credential:
Phone: 215-787-9001