Provider Demographics
NPI:1598923054
Name:NORTHERN HOME FOR CHILDREN AND FAMILY SERVICE
Entity Type:Organization
Organization Name:NORTHERN HOME FOR CHILDREN AND FAMILY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBBS-FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:215-482-1423
Mailing Address - Street 1:5301 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3757
Mailing Address - Country:US
Mailing Address - Phone:215-482-1423
Mailing Address - Fax:
Practice Address - Street 1:5301 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3757
Practice Address - Country:US
Practice Address - Phone:215-482-1423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007782000100Medicaid