Provider Demographics
NPI:1669510657
Name:PHILADELPHIA HEALTH MANAGEMENT CORP
Entity Type:Organization
Organization Name:PHILADELPHIA HEALTH MANAGEMENT CORP
Other - Org Name:CHILDLINK PROGRAM-DELCO
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-985-6233
Mailing Address - Street 1:260 S BROAD ST
Mailing Address - Street 2:18TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-5021
Mailing Address - Country:US
Mailing Address - Phone:215-985-6233
Mailing Address - Fax:267-765-2360
Practice Address - Street 1:260 S BROAD ST
Practice Address - Street 2:18TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-5021
Practice Address - Country:US
Practice Address - Phone:215-985-6233
Practice Address - Fax:267-765-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000016640021Medicare ID - Type UnspecifiedCHILDLINK PROGRAM-DELCO