Provider Demographics
NPI:1972777522
Name:CASA DE CONSEJERIA Y SALUD INTEGRAL, INC.
Entity Type:Organization
Organization Name:CASA DE CONSEJERIA Y SALUD INTEGRAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:215-634-3259
Mailing Address - Street 1:213 W ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-3617
Mailing Address - Country:US
Mailing Address - Phone:215-634-3259
Mailing Address - Fax:
Practice Address - Street 1:213 W ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3617
Practice Address - Country:US
Practice Address - Phone:215-634-3259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016561660001Medicaid
PA0016561660003Medicaid
PA0016561660002Medicaid