Provider Demographics
NPI:1053511329
Name:THE BEHAVIORAL WELLNESS CENTER AT GIRARD
Entity Type:Organization
Organization Name:THE BEHAVIORAL WELLNESS CENTER AT GIRARD
Other - Org Name:RTFA DUAL DX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GERRI
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-787-9001
Mailing Address - Street 1:801 W GIRARD AVE
Mailing Address - Street 2:ATTN BUSINESS OFFICE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4212
Mailing Address - Country:US
Mailing Address - Phone:215-787-2387
Mailing Address - Fax:
Practice Address - Street 1:801 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122
Practice Address - Country:US
Practice Address - Phone:215-787-2387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BEHAVIORAL WELLNESS CENTER AT GIRARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-24
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
PA100920261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007276960113Medicaid