Provider Demographics
NPI:1265872907
Name:CHILD GUIDANCE RESOURCE CENTERS
Entity type:Organization
Organization Name:CHILD GUIDANCE RESOURCE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PI
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:JARGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:484-454-8735
Mailing Address - Street 1:2000 OLD WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2712
Mailing Address - Country:US
Mailing Address - Phone:484-454-8700
Mailing Address - Fax:
Practice Address - Street 1:2901 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-3013
Practice Address - Country:US
Practice Address - Phone:484-454-8735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA112610251B00000X, 251S00000X
PA184890261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100005940Medicaid
PA112610Medicaid