Provider Demographics
NPI:1093906372
Name:OVERBROOK FRIEDLANDER PROGRAMS
Entity Type:Organization
Organization Name:OVERBROOK FRIEDLANDER PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-877-0017
Mailing Address - Street 1:1900 WYNNEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2535
Mailing Address - Country:US
Mailing Address - Phone:215-877-0006
Mailing Address - Fax:215-877-5039
Practice Address - Street 1:1900 WYNNEWOOD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2535
Practice Address - Country:US
Practice Address - Phone:215-877-0006
Practice Address - Fax:215-877-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15161100320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities