Healthcare Provider Details

I. General information

NPI: 1306090592
Provider Name (Legal Business Name): TRANSITION PHASE III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 CITY AVE MADISON BUILDING, SUITE 1207
PHILADELPHIA PA
19131-2908
US

IV. Provider business mailing address

3900 CITY AVE MADISON BUILDING, SUITE 1207
PHILADELPHIA PA
19131-2908
US

V. Phone/Fax

Practice location:
  • Phone: 215-878-3052
  • Fax:
Mailing address:
  • Phone: 215-878-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: JO BENOIT
Title or Position: CEO
Credential:
Phone: 215-878-2052