Provider Demographics
NPI:1578685624
Name:CENTRALIZED COMPREHENSIVE HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:CENTRALIZED COMPREHENSIVE HUMAN SERVICES, INC.
Other - Org Name:JOHN F KENNEDY BEHAVIORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:G
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:215-568-0860
Mailing Address - Street 1:112 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1510
Mailing Address - Country:US
Mailing Address - Phone:215-568-0860
Mailing Address - Fax:215-568-0769
Practice Address - Street 1:321 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1531
Practice Address - Country:US
Practice Address - Phone:215-568-0622
Practice Address - Fax:215-568-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA122000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000034530015Medicaid