Provider Demographics
NPI:1407909088
Name:HALL-MERCER CMH-MRC OF PENNSYLVANIA HOSP
Entity Type:Organization
Organization Name:HALL-MERCER CMH-MRC OF PENNSYLVANIA HOSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-796-4640
Mailing Address - Street 1:245 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3520
Mailing Address - Country:US
Mailing Address - Phone:215-796-4640
Mailing Address - Fax:609-770-7792
Practice Address - Street 1:245 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3520
Practice Address - Country:US
Practice Address - Phone:215-796-4640
Practice Address - Fax:609-770-7792
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENNSYLVANIA HOSPITAL OF THE UNIV OF PA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000049150013Medicaid