Provider Demographics
NPI:1538289822
Name:SOUTHWEST NU-STOP, INC.
Entity Type:Organization
Organization Name:SOUTHWEST NU-STOP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-729-2014
Mailing Address - Street 1:5616 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-5610
Mailing Address - Country:US
Mailing Address - Phone:215-729-2017
Mailing Address - Fax:215-729-2041
Practice Address - Street 1:5616 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-5610
Practice Address - Country:US
Practice Address - Phone:215-729-2017
Practice Address - Fax:215-729-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807374251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018064500002Medicaid
PA0018064500004Medicaid
PA0018064500001Medicaid
PA0018064500003Medicaid