Organization
NORTHEAST COMMUNITY CENTER FOR MH/MR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD KAUFMAN (EXECUTIVE DIRECTOR)
(215) 831-2800
Entity
Organization
Contact information
Practice address
4641 ROOSEVELT BLVD, ORLEANS BUILDING, PHILADELPHIA, PA 19124-2343
(215) 831-2800
Mailing address
4641 ROOSEVELT BLVD, ORLEANS BUILDING, PHILADELPHIA, PA 19124-2343
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
127450
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000034170061
—
PA
05
—
1000034170063
—
PA
05
—
1000034170072
—
PA
Enumeration date
12/16/2011
Last updated
12/16/2011
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