MEDICARE: PLACE OF REFUGE, 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	IN PROCESS	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	:	1508051368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLACE OF REFUGE, INC

Provider Business Mailing Address
First Line	:	2938 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2801
Country	:	US
Telephone Number	:	267-909-8550
Fax Number	:	267-909-8552

Provider Business Practice Location Address
First Line	:	2938 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2801
Country	:	US
Telephone Number	:	267-909-8550
Fax Number	:	267-909-8552

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR (INTERIM)
Name	:	BRYAN DICKEY
Credential	:
Telephone Number	:	267-909-8550

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	10/03/2024

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Directions to “PLACE OF REFUGE, INC ” Practice Location

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