Healthcare Provider Details

I. General information

NPI: 1477985372
Provider Name (Legal Business Name): 3300 HENRY AVENUE OPERATING COMPANY, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HENRY AVE
PHILADELPHIA PA
19129-1121
US

IV. Provider business mailing address

500 SENECA ST STE 100
BUFFALO NY
14204-1963
US

V. Phone/Fax

Practice location:
  • Phone: 215-297-5555
  • Fax:
Mailing address:
  • Phone: 716-361-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY KENWORTHY
Title or Position: SR. DIRECTOR REVENUE CYCLE MGMT
Credential:
Phone: 716-361-6636