Provider Demographics
NPI:1821453150
Name:COMMUNITY OUTREACH PROGRAM
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MHS,
Authorized Official - Phone:215-473-1181
Mailing Address - Street 1:1311 N 52ND STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131
Mailing Address - Country:US
Mailing Address - Phone:215-473-1181
Mailing Address - Fax:215-879-2723
Practice Address - Street 1:1311 N 52ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4412
Practice Address - Country:US
Practice Address - Phone:215-473-1181
Practice Address - Fax:215-879-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness