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General NPI Number Information
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NPI Number | 1760718472
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Entity Type | Organization
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Legal Business Name | MINSEC TREATMENT LLC
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 1625 WASHINGTON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19146-2045
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Country | US
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Telephone | 215-732-1890
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Fax | 215-732-2063
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Provider Business Mailing Address
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Address Line | 1625 WASHINGTON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19146-2045
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Country | US
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Telephone | 215-732-1890
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Fax | 215-732-2063
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DEBRA A MILLER
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Credential |
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Telephone | 215-744-9601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 807410
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 807410
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License Number State | PA
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