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General NPI Number Information
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NPI Number | 1669599973
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Entity Type | Organization
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Legal Business Name | WEST PHILADELPHIA COMMUNITY MH CONSORTIUM INC.
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 451 S UNIVERSITY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4544
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Country | US
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Telephone | 215-596-8100
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Fax | 215-382-4405
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Provider Business Mailing Address
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Address Line | 3751 ISLAND AVE STE 303
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City | PHILADELPHIA
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State | PA
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Zip | 19153-3237
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Country | US
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Telephone | 215-596-8100
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Fax | 215-382-0511
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. JOHN F WHITE JR.
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Credential |
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Telephone | 215-596-8100
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 1007155230047
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License Number State | PA
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