Provider Demographics
NPI:1548414923
Name:PUBLIC HEALTH MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:PUBLIC HEALTH MANAGEMENT CORPORATION
Other - Org Name:FORENSIC INTENSIVE RECOVERY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-731-2042
Mailing Address - Street 1:1500 MARKET ST
Mailing Address - Street 2:CENTRE SQUARE EAST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 MARKET ST
Practice Address - Street 2:CENTRE SQUARE EAST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2100
Practice Address - Country:US
Practice Address - Phone:215-731-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000016640055Medicaid