Provider Demographics
NPI:1235205584
Name:ADDICTION MEDICINE AND HEALTH ADVOCATES, INCORPORATED
Entity Type:Organization
Organization Name:ADDICTION MEDICINE AND HEALTH ADVOCATES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEXCUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:215-923-4202
Mailing Address - Street 1:928 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4226
Mailing Address - Country:US
Mailing Address - Phone:215-923-4202
Mailing Address - Fax:215-923-4751
Practice Address - Street 1:928 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4226
Practice Address - Country:US
Practice Address - Phone:215-923-4202
Practice Address - Fax:215-923-4751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807161251K00000X, 261Q00000X, 261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadoneGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007781200004Medicaid
PA1007781200005Medicaid