Healthcare Provider Details

I. General information

NPI: 1174816276
Provider Name (Legal Business Name): RESOURCES FOR HUMAN DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 MULBERRY DR
WALNUTPORT PA
18088-9686
US

IV. Provider business mailing address

4700 WISSAHICKON AVE SUITE 126
PHILADELPHIA PA
19144-4248
US

V. Phone/Fax

Practice location:
  • Phone: 610-767-4710
  • Fax: 484-298-1338
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0501476071
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: ROBERT FISHMAN
Title or Position: EXECUTIVE
Credential:
Phone: 215-951-0300