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General NPI Number Information
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NPI Number | 1669883013
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Entity Type | Organization
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Legal Business Name | NORTHEAST COMMUNITY CENTER FOR MH/MR
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 4641 ROOSEVELT BLVD ORLEANS BLDG
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2343
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Country | US
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Telephone | 215-831-2826
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Fax |
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Provider Business Mailing Address
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Address Line | 4641 ROOSEVELT BLVD ORLEANS BLDG
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2343
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Country | US
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Telephone | 215-831-2826
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Fax |
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Authorized Official
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Title or Position | MIS DIRECTOT
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Name | DENNIS GUSCOTT
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Credential |
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Telephone | 215-831-2826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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