MEDICARE: CENTRALIZED COMPREHENSIVE HUMAN SERVICES, 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
1	251S00000X	Community/Behavioral Health Agency	800284	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	:	1285756916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRALIZED COMPREHENSIVE HUMAN SERVICES, INC.

Provider Business Mailing Address
First Line	:	112 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1510
Country	:	US
Telephone Number	:	215-568-0860
Fax Number	:	215-568-0769

Provider Business Practice Location Address
First Line	:	907 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-1013
Country	:	US
Telephone Number	:	215-568-0860
Fax Number	:	215-568-0769

Authorized Official
Title or Position	:	VP FINANCE
Name	:	ALICE G YOUNG
Credential	:	MBA
Telephone Number	:	215-568-0860

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	03/16/2012

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