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General NPI Number Information
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NPI Number | 1427531698
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Entity Type | Organization
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Legal Business Name | PENN-JERSEY INTEGRATED HUMAN SERVICES INC
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 6272 KINDRED ST
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City | PHILADELPHIA
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State | PA
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Zip | 19149-2805
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Country | US
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Telephone | 215-964-2135
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Fax |
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Provider Business Mailing Address
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Address Line | 7515 BOULEVARD AVE
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City | PENNSAUKEN
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State | NJ
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Zip | 08110-2576
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Country | US
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Telephone | 856-495-8287
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. FENNEL KPOLIE
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Credential | LSW
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Telephone | 856-495-8287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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