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General NPI Number Information
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NPI Number | 1023941655
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Entity Type | Organization
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Legal Business Name | PENN
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 4040 MARKET ST FL 2
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3003
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Country | US
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Telephone | 215-662-8747
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 MARKET ST FL 2
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3003
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Country | US
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Telephone | 215-662-8747
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH/ADDICTION'S COUNS
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Name | MR. EUGENE VERNELL MOSES III
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Credential | MA; CADC
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Telephone | 215-662-8724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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