Provider Demographics
NPI:1841802592
Name:COMMUNITY HEALTH & WELLNESS SERVICES, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH & WELLNESS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:YAHAYA
Authorized Official - Middle Name:EHIGIE
Authorized Official - Last Name:ENAKHIMION
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:215-392-2961
Mailing Address - Street 1:312 MEMORIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1714
Mailing Address - Country:US
Mailing Address - Phone:215-287-7260
Mailing Address - Fax:
Practice Address - Street 1:COMMUNITY HEALTH & WELLNESS SERVICES INC
Practice Address - Street 2:2600 SOUTHAMPTON RD
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-287-7260
Practice Address - Fax:215-550-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-22
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103112273Medicaid