Provider Demographics
NPI:1891992442
Name:BUSTLETON MENTAL HEALTH INSTITUTE, INC
Entity Type:Organization
Organization Name:BUSTLETON MENTAL HEALTH INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATONOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-464-3838
Mailing Address - Street 1:9551 BUSTLETON AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3800
Mailing Address - Country:US
Mailing Address - Phone:215-464-3838
Mailing Address - Fax:215-464-3899
Practice Address - Street 1:9551 BUSTLETON AVE STE 2B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3800
Practice Address - Country:US
Practice Address - Phone:215-464-3838
Practice Address - Fax:215-464-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA129270251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management