Provider Demographics
NPI:1316579923
Name:COMMUNITY COUNCIL FOR MENTAL HEALTH & MENTAL RETARDATION INC.
Entity Type:Organization
Organization Name:COMMUNITY COUNCIL FOR MENTAL HEALTH & MENTAL RETARDATION INC.
Other - Org Name:COMMUNITY COUNCIL FOR MH/MR, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:REKIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-921-3713
Mailing Address - Street 1:4900 WYALUSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-5127
Mailing Address - Country:US
Mailing Address - Phone:215-921-3713
Mailing Address - Fax:215-827-5276
Practice Address - Street 1:1211 CHESTNUT ST FL 8
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4103
Practice Address - Country:US
Practice Address - Phone:267-514-3500
Practice Address - Fax:267-514-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health