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General NPI Number Information
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NPI Number | 1790213122
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Entity Type | Organization
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Legal Business Name | CENTER CITY RECOVERY, LLC
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1880 JFK BLVD STE 1110
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City | PHILADELPHIA
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State | PA
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Zip | 19103-7422
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Country | US
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Telephone | 215-398-5304
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Fax |
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Provider Business Mailing Address
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Address Line | 1880 JFK BLVD STE 1110
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City | PHILADELPHIA
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State | PA
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Zip | 19103-7422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | VALERIE DORELIEN
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Credential |
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Telephone | 215-398-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 807440
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License Number State | PA
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