Organization
COMMUNITY COUNCIL FOR MH/MR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EARLE BRADFORD (CEO)
(215) 473-7033
Entity
Organization
Contact information
Practice address
4900 WYALUSING AVE, PHILADELPHIA, PA 19131-5127
(215) 473-7033
(215) 473-5405
Mailing address
4900 WYALUSING AVE, PHILADELPHIA, PA 19131-5127
(215) 473-7033
(215) 473-5405
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
121630
PA
Other
Enumeration date
09/20/2006
Last updated
08/22/2020
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