Organization
WMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAKISA S GALLMAN (VP ADMINISTRATIVE SERVICES)
(215) 276-3922
Entity
Organization
Contact information
Practice address
1939 S JUNIPER ST, PHILADELPHIA, PA 19148-2217
(215) 271-5822
(215) 271-5881
Mailing address
6711 OLD YORK RD, PHILADELPHIA, PA 19126-2841
(215) 276-3922
(215) 276-1249
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001680493
—
PA
Enumeration date
05/14/2020
Last updated
05/14/2020
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