Organization
PHILEO DISTRICT
Active
Organization
PHILEO DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN Z JOHNSON II MSS (DEVELOPMENT OFFICER)
(267) 864-7794
Entity
Organization
Contact information
Practice address
6401 OGONTZ AVE, PHILADELPHIA, PA 19126-3406
(267) 874-6694
Mailing address
6901 OLD YORK RD, C404, PHILADELPHIA, PA 19126-2234
(267) 864-7794
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1208532600001
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028532600001
—
PA
Enumeration date
03/21/2017
Last updated
03/21/2017
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