MEDICARE: RESOURCES FOR HUMAN DEVELOPMENT

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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	1000017080268	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1104957810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESOURCES FOR HUMAN DEVELOPMENT

Provider Business Mailing Address
First Line	:	4700 WISSAHICKON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	215-951-0300
Fax Number	:	215-951-0312

Provider Business Practice Location Address
First Line	:	5019 PENN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-2627
Country	:	US
Telephone Number	:	215-951-0300
Fax Number	:	215-951-0312

Authorized Official
Title or Position	:	AR COORDINATOR
Name	:	MS. ADRIENNE ROTELLA
Credential	:	MS
Telephone Number	:	215-951-0300

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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