Organization
SELF INC.
Active
Organization
SELF INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATHANIEL ROBINSON (CPO)
(215) 496-9610
Entity
Organization
Contact information
Practice address
1425 ARCH ST, SUITE 300, PHILADELPHIA, PA 19102-1507
(215) 496-9610
Mailing address
1425 ARCH ST, SUITE 300, PHILADELPHIA, PA 19102-1507
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
807186
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350-1
—
PA
05
—
350-13
—
PA
05
—
350-9
—
PA
05
—
375-11
—
PA
Enumeration date
01/18/2007
Last updated
08/08/2007
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