Organization
NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH & MENTAL RETARDATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID COMO LCSW (EXECUTIVE DIRECTOR)
(215) 831-2800
Entity
Organization
Contact information
Practice address
4641 ROOSEVELT BLVD, PHILADELPHIA, PA 19124-2343
(215) 831-2800
(215) 831-2929
Mailing address
4641 ROOSEVELT BLVD, PHILADELPHIA, PA 19124-2343
(215) 831-2800
(215) 831-2929
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
189100
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000034170077
—
PA
Enumeration date
08/01/2014
Last updated
08/01/2014
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