Provider Demographics
NPI:1710040878
Name:GREATER PHILADELPHIA HEALTH ACTION INC.
Entity Type:Organization
Organization Name:GREATER PHILADELPHIA HEALTH ACTION INC.
Other - Org Name:GPHA WOODLAND AVE. DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPEC.
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:TINA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-925-2400
Mailing Address - Street 1:1401 S 31ST STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-3506
Mailing Address - Country:US
Mailing Address - Phone:215-925-2400
Mailing Address - Fax:215-925-9162
Practice Address - Street 1:5501 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-5607
Practice Address - Country:US
Practice Address - Phone:215-724-4700
Practice Address - Fax:215-724-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental