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General NPI Number Information
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NPI Number | 1538289822
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Entity Type | Organization
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Legal Business Name | SOUTHWEST NU-STOP, INC.
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5616 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19143-5610
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Country | US
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Telephone | 215-729-2017
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Fax | 215-729-2041
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Provider Business Mailing Address
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Address Line | 5616 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19143-5610
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Country | US
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Telephone | 215-729-2017
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Fax | 215-729-2041
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. LLOYD THOMAS REID
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Credential | PH.D.
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Telephone | 215-729-2014
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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 | 807374
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License Number State | PA
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