Provider Demographics
NPI:1275674871
Name:INTERIM HOUSE INC
Entity Type:Organization
Organization Name:INTERIM HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-731-2042
Mailing Address - Street 1:333 W UPSAL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-4010
Mailing Address - Country:US
Mailing Address - Phone:215-731-2042
Mailing Address - Fax:267-765-2380
Practice Address - Street 1:333 W UPSAL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-4010
Practice Address - Country:US
Practice Address - Phone:215-731-2042
Practice Address - Fax:267-765-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007781760005Medicare ID - Type UnspecifiedINTERIM HOUSE, INC.