Healthcare Provider Details

I. General information

NPI: 1356470819
Provider Name (Legal Business Name): RESOURCES FOR HUMAN DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10908 KIRBY DR
PHILADELPHIA PA
19154-4206
US

IV. Provider business mailing address

4700 WISSAHICKON AVE
PHILADELPHIA PA
19144-4248
US

V. Phone/Fax

Practice location:
  • Phone: 215-848-1947
  • Fax: 215-848-1601
Mailing address:
  • Phone: 215-951-0300
  • Fax: 215-951-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1000017080443
License Number StatePA

VIII. Authorized Official

Name: MS. ADRIENNE ROTELLA
Title or Position: AR COORDINATOR
Credential: MS
Phone: 215-951-0300