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General NPI Number Information
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NPI Number | 1851390561
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Entity Type | Organization
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Legal Business Name | CORECARE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 111 N 49TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-2718
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Country | US
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Telephone | 215-471-2488
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Fax |
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Provider Business Mailing Address
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Address Line | 111 N 49TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-2718
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Country | US
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Telephone | 215-471-2488
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ROSE S DIOTTAVIO
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Credential |
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Telephone | 215-471-2853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | 807208
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 807208
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 197910
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License Number State | PA
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