Provider Demographics
NPI:1679085443
Name:WARWICK FAMILY BASED PROGRAM INC
Entity Type:Organization
Organization Name:WARWICK FAMILY BASED PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-525-7000
Mailing Address - Street 1:800 CLARMONT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5705
Mailing Address - Country:US
Mailing Address - Phone:267-525-7000
Mailing Address - Fax:267-525-7010
Practice Address - Street 1:1001 NOR BATH BLVD
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-8909
Practice Address - Country:US
Practice Address - Phone:267-525-7000
Practice Address - Fax:267-525-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA105120251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016431890001Medicaid