Organization
SHRO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KINA NORTHINGTON (DIRECTOR)
(267) 777-0190
Entity
Organization
Contact information
Practice address
5353 LINDBERGH BLVD, PHILADELPHIA, PA 19143-5829
(267) 777-0190
Mailing address
5353 LINDBERGH BLVD, PHILADELPHIA, PA 19143-5829
(267) 777-0190
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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