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General NPI Number Information
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NPI Number | 1508051368
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Entity Type | Organization
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Legal Business Name | PLACE OF REFUGE, INC
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 2938 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19133-2801
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Country | US
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Telephone | 267-909-8550
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Fax | 267-909-8552
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Provider Business Mailing Address
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Address Line | 2938 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19133-2801
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Country | US
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Telephone | 267-909-8550
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Fax | 267-909-8552
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR (INTERIM)
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Name | BRYAN DICKEY
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Credential |
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Telephone | 267-909-8550
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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 | IN PROCESS
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License Number State | PA
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