MEDICARE: MEN & WOMEN FOR HUMAN EXCELLENCE, 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	251K00000X	Public Health or Welfare Agency		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1011438420002	OTHER	PA	MENTAL HEALTH
2	1011438420002	OTHER	PA	DRUG AND ALCOHOL

General Provider Information

NPI Number	:	1689700551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEN & WOMEN FOR HUMAN EXCELLENCE, INC.

Provider Business Mailing Address
First Line	:	2603 CECIL B MOORE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2826
Country	:	US
Telephone Number	:	215-769-7045
Fax Number	:	215-769-7046

Provider Business Practice Location Address
First Line	:	2603 CECIL B MOORE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2826
Country	:	US
Telephone Number	:	215-769-7045
Fax Number	:	215-769-7046

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. KEITH NAVARRO JOHNSON
Credential	:	MSW
Telephone Number	:	215-769-7045

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/14/2015

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