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General NPI Number Information
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NPI Number | 1427589589
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Entity Type | Organization
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Legal Business Name | PHILEO DISTRICT
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 6401 OGONTZ AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19126-3406
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Country | US
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Telephone | 267-874-6694
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Fax |
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Provider Business Mailing Address
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Address Line | 6901 OLD YORK RD C404
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City | PHILADELPHIA
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State | PA
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Zip | 19126-2234
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Country | US
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Telephone | 267-864-7794
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Fax |
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Authorized Official
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Title or Position | DEVELOPMENT OFFICER
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Name | MR. STEVEN Z JOHNSON II
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Credential | MSS
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Telephone | 267-864-7794
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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 | 1208532600001
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License Number State | PA
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