=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164897658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLUTION HOUSE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2015
-----------------------------------------------------
Last Update Date | 12/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4143 PAUL ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19124-4607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-316-2902
-----------------------------------------------------
Fax | 888-316-2902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 S 2ND ST SUITE 205
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19147-1612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-316-2902
-----------------------------------------------------
Fax | 888-316-2902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MARTIN J FISHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-316-2902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3245S0500X
-----------------------------------------------------
Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------