Organization
NUEVA VIDA MENTAL HEALTH CENTER
Active
Other names
NUEVA VIDA BEHAVIORAL HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GODRHAT P SHOLEVAR MD (EXECUTIVE DIRECTOR)
(215) 229-0956
Entity
Organization
Contact information
Practice address
618 W LEHIGH AVE, PHILADELPHIA, PA 19133-2227
(215) 229-8857
(215) 229-0654
Mailing address
618 W LEHIGH AVE, PHILADELPHIA, PA 19133-2227
(215) 229-8857
(215) 229-0654
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016954870003
PROMISE NUMBER
PA
Enumeration date
01/24/2007
Last updated
09/10/2012
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