Provider Demographics
NPI:1760718472
Name:MINSEC TREATMENT LLC
Entity Type:Organization
Organization Name:MINSEC TREATMENT LLC
Other - Org Name:MINSEC TREATMENT-SOUTH
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-744-9601
Mailing Address - Street 1:1625 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2045
Mailing Address - Country:US
Mailing Address - Phone:215-732-1890
Mailing Address - Fax:215-732-2063
Practice Address - Street 1:1625 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2045
Practice Address - Country:US
Practice Address - Phone:215-732-1890
Practice Address - Fax:215-732-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807410251K00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA774372000OtherMAGELLAN BH OF PA
PA88868OtherCOMMUNITY BEHAVIORAL HEALTH
PA01824913Medicaid
PAD0048OtherBHSI OF PHILADELPHIA