Provider Demographics
NPI:1346426400
Name:JUVENILE JUSTICE CENTER OF PHILADELPHIA
Entity Type:Organization
Organization Name:JUVENILE JUSTICE CENTER OF PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-849-2112
Mailing Address - Street 1:100 W COULTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3402
Mailing Address - Country:US
Mailing Address - Phone:215-849-2112
Mailing Address - Fax:215-849-0393
Practice Address - Street 1:100 W COULTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3402
Practice Address - Country:US
Practice Address - Phone:215-849-2112
Practice Address - Fax:215-849-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA192800251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health