Healthcare Provider Details

I. General information

NPI: 1346375680
Provider Name (Legal Business Name): COMMUNITY INTERACTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S CHESTER RD
SWARTHMORE PA
19081-2226
US

IV. Provider business mailing address

740 S CHESTER RD
SWARTHMORE PA
19081-2226
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-9008
  • Fax: 610-328-4597
Mailing address:
  • Phone: 610-328-9008
  • Fax: 610-328-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number329300
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS004668L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number137660
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100000228
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMPI

VIII. Authorized Official

Name: GARY CLIFT
Title or Position: SENIOR VICE PRESIDENT & CFO
Credential:
Phone: 610-328-9008