Provider Demographics
NPI:1497257851
Name:JEVS HUMAN SERVICES
Entity Type:Organization
Organization Name:JEVS HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-854-1800
Mailing Address - Street 1:1845 WALNUT STREET, 7TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:215-854-1800
Mailing Address - Fax:
Practice Address - Street 1:1521 CONCORD PIKE STE 301
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3644
Practice Address - Country:US
Practice Address - Phone:800-610-7910
Practice Address - Fax:866-856-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2024-02-28
Deactivation Date:2024-02-02
Deactivation Code:
Reactivation Date:2024-02-08
Provider Licenses
StateLicense IDTaxonomies
DE2009105969103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA000000379Medicaid