Provider Demographics
NPI:1407179260
Name:WEST PHILA MN HLTH CONSORTIUM, INC
Entity Type:Organization
Organization Name:WEST PHILA MN HLTH CONSORTIUM, INC
Other - Org Name:THE CONSORTIUM, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING CEO/PERSONNEL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-596-8100
Mailing Address - Street 1:3801 MARKET ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3153
Mailing Address - Country:US
Mailing Address - Phone:215-596-8100
Mailing Address - Fax:215-382-4405
Practice Address - Street 1:5501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3205
Practice Address - Country:US
Practice Address - Phone:215-748-8400
Practice Address - Fax:215-748-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health