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General NPI Number Information
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NPI Number | 1184016651
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Entity Type | Organization
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Legal Business Name | THW GROUP LLC
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Dates
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Enumeration Date | 02/20/2015
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 7900 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3041
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Country | US
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Telephone | 215-335-3520
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Fax | 215-335-3130
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Provider Business Mailing Address
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Address Line | 7900 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19136-3041
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Country | US
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Telephone | 215-335-3520
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Fax | 215-335-3130
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MICHELLE YANOVSKY
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Credential |
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Telephone | 215-335-3520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 807425
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License Number State | PA
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