Organization
COMMUNITY COUNCIL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES PAIGE (CHIEF INFORMATION OFFICER)
(215) 473-7033
Entity
Organization
Contact information
Practice address
4900 WYALUSING AVE, PHILADELPHIA, PA 19131-5127
(215) 473-7033
(215) 933-6926
Mailing address
4900 WYALUSING AVE, PHILADELPHIA, PA 19131-5127
(215) 473-7033
(215) 933-6926
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
121630
PA
251S00000X
Community/Behavioral Health Agency
Primary
121630
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000049600021
—
PA
05
—
1000049600024
—
PA
05
—
1000049600025
—
PA
Enumeration date
05/15/2007
Last updated
03/17/2016
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