Provider Demographics
NPI:1407981848
Name:ST. MARY'S VILLA FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:ST. MARY'S VILLA FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:215-643-7676
Mailing Address - Street 1:701 S BETHLEHEM PIKE
Mailing Address - Street 2:PO BOX 388
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5818
Mailing Address - Country:US
Mailing Address - Phone:215-643-7676
Mailing Address - Fax:215-643-9029
Practice Address - Street 1:701 S BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5818
Practice Address - Country:US
Practice Address - Phone:215-643-7676
Practice Address - Fax:215-643-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility