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General NPI Number Information
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NPI Number | 1699892935
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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 | 08/22/2020
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Provider Practice Location Address
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Address Line | 4300 WESTMINSTER AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1308
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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 | 3801 MARKET ST SUITE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3153
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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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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 128620
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License Number State | PA
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