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General NPI Number Information
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NPI Number | 1821453150
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Entity Type | Organization
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Legal Business Name | COMMUNITY OUTREACH PROGRAM
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 1311 N 52ND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19131-4412
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Country | US
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Telephone | 215-473-1181
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Fax | 215-879-2723
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Provider Business Mailing Address
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Address Line | 1311 N 52ND STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19131
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Country | US
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Telephone | 215-473-1181
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Fax | 215-879-2723
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Authorized Official
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Title or Position | EXCUTIVE DIRECTOR
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Name | MRS. ELIZABETH L HARDEN
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Credential | M.H.S,
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Telephone | 215-473-1181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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