=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275753808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHIL. COUNTY-DEPT. OF HEALTH TSM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 MARKET ST 5TH FLOOR, SUITE 5200
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19106-1538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-685-5906
-----------------------------------------------------
Fax | 215-685-5959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 MARKET ST 7TH FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-2934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-685-5460
-----------------------------------------------------
Fax | 215-685-5467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPUTY DIRECTOR DBH MRS
-----------------------------------------------------
Name | MR. MICHAEL J COVONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-685-5460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------