Provider Demographics
NPI:1467635110
Name:MERAKEY IDD PHILADELPHIA
Entity Type:Organization
Organization Name:MERAKEY IDD PHILADELPHIA
Other - Org Name:THE ASSOCIATION FOR INDEPENDENT GROWTH, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORP SR. DIRECTOR OF BUSINESS OPS
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-836-3131
Mailing Address - Street 1:4700 WISSAHICKON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:215-320-2040
Mailing Address - Fax:215-320-2041
Practice Address - Street 1:2991 W SCHOOL HOUSE LN APT C12E
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-5350
Practice Address - Country:US
Practice Address - Phone:215-844-2758
Practice Address - Fax:215-320-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA126430320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness