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General NPI Number Information
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NPI Number | 1982763017
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Entity Type | Organization
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Legal Business Name | WESTMEADE CENTER
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 06/26/2008
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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 | 215-471-2687
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Fax | 215-471-2845
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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 | 215-471-2687
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Fax | 215-471-2845
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ROSE DIOTTAVIO
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Credential |
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Telephone | 215-471-2687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 187750
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License Number State | PA
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