Organization
MINSEC TREATMENT LLC
Active
Other names
MinSec Treatment-South
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA A MILLER (BILLING MANAGER)
(215) 744-9601
Entity
Organization
Contact information
Practice address
1625 WASHINGTON AVE, PHILADELPHIA, PA 19146-2045
(215) 732-1890
(215) 732-2063
Mailing address
1625 WASHINGTON AVE, PHILADELPHIA, PA 19146-2045
(215) 732-1890
(215) 732-2063
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
807410
PA
261Q00000X
Clinic/Center
Primary
807410
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01824913
—
PA
01
—
774372000
MAGELLAN BH OF PA
PA
01
—
88868
COMMUNITY BEHAVIORAL HEALTH
PA
01
—
D0048
BHSI OF PHILADELPHIA
PA
Enumeration date
10/30/2009
Last updated
10/30/2009
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