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General NPI Number Information
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NPI Number | 1013129709
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Entity Type | Organization
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Legal Business Name | INTERVENTIVE CARE CRISIS MANAGEMENT NETWORK
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 3800 NORTH BROAD STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19140
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Country | US
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Telephone | 215-225-5566
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Fax | 215-949-3483
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Provider Business Mailing Address
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Address Line | 3800 N BROAD ST FL 2
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City | PHILADELPHIA
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State | PA
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Zip | 19140-3610
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Country | US
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Telephone | 215-225-5566
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Fax | 215-949-3483
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS YATES
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Credential |
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Telephone | 267-994-7752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 102930
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License Number State | PA
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