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General NPI Number Information
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NPI Number | 1891974929
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Entity Type | Organization
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Legal Business Name | WEST PHILADELPHIA COMMUNITY MENTAL HEALTH CONSORTIUM, INC.
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 5429 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3300
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Country | US
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Telephone | 215-596-8100
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Fax |
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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 | CEO
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Name | MR. JOHN 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1007155230082
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License Number State | PA
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Taxonomy #2
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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 | 1007155230082
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License Number State | PA
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