Organization
INTERVENTIVE CARE CRISIS MANAGEMENT NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS YATES (PRESIDENT)
(267) 994-7752
Entity
Organization
Contact information
Practice address
3800 NORTH BROAD STREET, PHILADELPHIA, PA 19140
(215) 225-5566
(215) 949-3483
Mailing address
3800 N BROAD ST FL 2, PHILADELPHIA, PA 19140-3610
(215) 225-5566
(215) 949-3483
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
102930
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016910490001
PROMISE MAID
PA
Enumeration date
05/04/2007
Last updated
12/19/2007
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