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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1720072366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESOURCES FOR HUMAN DEVELOPMENT

Provider Business Mailing Address
First Line	:	4700 WISSAHICKON AVE
Second Line	:	SUITE 118
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-4248
Country	:	US
Telephone Number	:	215-438-4779
Fax Number	:	215-298-0501

Provider Business Practice Location Address
First Line	:	4333 KELLY DR
Second Line	:	1ST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1760
Country	:	US
Telephone Number	:	215-843-2580
Fax Number	:	215-843-4086

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICIER
Name	:	BOB FISHMAN
Credential	:
Telephone Number	:	215-951-0300

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	04/23/2008

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