=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558695734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESOURCES FOR HUMAN DEVELOPMENT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2009
-----------------------------------------------------
Last Update Date | 09/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3653 N 15TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-228-2323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 WISSAHICKON AVE SUITE 126
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19144-4248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ROBERT FISHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-951-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 807324
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------