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General NPI Number Information
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NPI Number | 1265872907
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Entity Type | Organization
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Legal Business Name | CHILD GUIDANCE RESOURCE CENTERS
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 2901 ISLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19153-3013
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Country | US
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Telephone | 484-454-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 OLD WEST CHESTER PIKE
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City | HAVERTOWN
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State | PA
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Zip | 19083-2712
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Country | US
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Telephone | 484-454-8700
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PI
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Name | MR. TODD JARGER
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Credential | CPA
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Telephone | 484-454-8735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 112610
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 184890
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 112610
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License Number State | PA
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