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General NPI Number Information
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NPI Number | 1275674871
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Entity Type | Organization
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Legal Business Name | INTERIM HOUSE INC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 333 W UPSAL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-4010
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Country | US
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Telephone | 215-731-2042
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Fax | 267-765-2380
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Provider Business Mailing Address
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Address Line | 333 W UPSAL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-4010
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Country | US
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Telephone | 215-731-2042
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Fax | 267-765-2380
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Authorized Official
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Title or Position | BILLING OORDINATOR
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Name | SHANTE PENNINGTON
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Credential |
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Telephone | 215-731-2042
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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 |
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License Number State |
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