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Organization

THOMAS JEFFERSON UNIVERSITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHELLE CALVANO BA (BUSINESS MANAGER)
(215) 955-1952
Entity
Organization

Contact information

Practice address
1239 SPRING GARDEN ST, PHILADELPHIA, PA 19123-3206
(215) 763-1020
(215) 763-4640
Mailing address
1233 LOCUST ST STE 401, PHILADELPHIA, PA 19107-5459
(215) 955-1952
(215) 568-6414

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
800000127
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1007571300097
PA
Enumeration date
03/28/2007
Last updated
10/17/2017
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