MEDICARE: WESTMEADE CENTER

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	187750	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	:	1982763017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTMEADE CENTER

Provider Business Mailing Address
First Line	:	111 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2718
Country	:	US
Telephone Number	:	215-471-2687
Fax Number	:	215-471-2845

Provider Business Practice Location Address
First Line	:	111 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2718
Country	:	US
Telephone Number	:	215-471-2687
Fax Number	:	215-471-2845

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ROSE DIOTTAVIO
Credential	:
Telephone Number	:	215-471-2687

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	06/26/2008

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Directions to “WESTMEADE CENTER ” Practice Location

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