Provider Demographics
NPI:1073512331
Name:BELMONT CENTER FOR COMPRHENSIVE TREATMENT
Entity Type:Organization
Organization Name:BELMONT CENTER FOR COMPRHENSIVE TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-456-6611
Mailing Address - Street 1:4200 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1625
Mailing Address - Country:US
Mailing Address - Phone:215-456-6611
Mailing Address - Fax:215-457-4304
Practice Address - Street 1:4200 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-1625
Practice Address - Country:US
Practice Address - Phone:215-456-6611
Practice Address - Fax:215-457-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA117160261Q00000X, 283Q00000X
PA121960283Q00000X
PA177920283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007417750001Medicaid
PA1007417750009Medicaid
PA1007417750005Medicaid
PA1007417750013Medicaid
PA1007417750018Medicaid
PA1007417750005Medicaid