Provider Demographics
NPI:1568740611
Name:COMMUNITY COUNCIL FOR MENTAL HEALTH AND MENTAL RETARDATION
Entity Type:Organization
Organization Name:COMMUNITY COUNCIL FOR MENTAL HEALTH AND MENTAL RETARDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:REKIYAB
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-473-7033
Mailing Address - Street 1:4900 WYALUSING AVE
Mailing Address - Street 2:MAIN BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-5127
Mailing Address - Country:US
Mailing Address - Phone:215-473-7033
Mailing Address - Fax:215-827-5276
Practice Address - Street 1:714 MARKET ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2326
Practice Address - Country:US
Practice Address - Phone:215-473-7033
Practice Address - Fax:215-827-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA121630251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health