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General NPI Number Information
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NPI Number | 1417302993
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Entity Type | Organization
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Legal Business Name | THE BEHAVIORAL WELLNESS CENTER AT GIRARD
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 4001 FORD RD
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2833
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Country | US
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Telephone | 215-877-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 801 W GIRARD AVE ATTN BUSINESS OFFICE
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City | PHILADELPHIA
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State | PA
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Zip | 19122-4212
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Country | US
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Telephone | 215-787-2424
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. XAVIER BANCROFT
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Credential |
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Telephone | 215-787-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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