Provider Demographics
NPI:1023517646
Name:CROZER KEYSTONE HEALTH CENTER
Entity type:Organization
Organization Name:CROZER KEYSTONE HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MSW
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:484-343-5459
Mailing Address - Street 1:1308 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1327
Mailing Address - Country:US
Mailing Address - Phone:484-343-5459
Mailing Address - Fax:
Practice Address - Street 1:710 S OLD MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5024
Practice Address - Country:US
Practice Address - Phone:610-619-9870
Practice Address - Fax:610-619-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1265529705Medicaid