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Organization

COMMUNITY COUNCIL FOR MH/MR, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ALEX MOORE (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) 921-3713
(215) 827-5276

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
261QC1500X
Community Health Clinic/Center
Primary
121630
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100004960
PA
01
600003557
MAGELLAN
PA
Enumeration date
09/20/2006
Last updated
05/11/2026
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