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Organization

57HUNDRED GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ILA SMITH (CEO)
(817) 484-8628
Entity
Organization

Contact information

Practice address
3217 W NORRIS ST, PHILADELPHIA, PA 19121-1716
(817) 484-8628
Mailing address
2 BALA PLZ STE 300, BALA CYNWYD, PA 19004-1512
(267) 879-1616

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
12/23/2020
Last updated
12/23/2020
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