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NPI Code Detail

MEDICARE: COMMUNITY COUNCIL FOR MENTAL HEALTH & MENTAL RETARDATION INC

MEDICARE: COMMUNITY COUNCIL FOR MENTAL HEALTH & MENTAL RETARDATION INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency121630PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093849986
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY COUNCIL FOR MENTAL HEALTH & MENTAL RETARDATION INC
Provider Business Mailing Address
First Line : 4900 WYALUSING AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19131-5127
Country : US
Telephone Number : 267-979-4290
Fax Number : 215-827-5276
Provider Business Practice Location Address
First Line : 4900 WYALUSING AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19131-5127
Country : US
Telephone Number : 215-473-7033
Fax Number : 215-827-5276
Authorized Official
Title or Position : DIRECTOR OF BILLING/CREDENTIALING
Name : REKIYA BELL
Credential :
Telephone Number : 215-921-3713
Provider Enumeration Date : 03/15/2007
Last Update Date : 05/11/2026

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Directions to “COMMUNITY COUNCIL FOR MENTAL HEALTH & MENTAL RETARDATION INC ” Practice Location

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