Provider Demographics
NPI:1356605455
Name:INTERAMERICAN BEHAVIORAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:INTERAMERICAN BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-356-7586
Mailing Address - Street 1:430 W ANNSBURY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1539
Mailing Address - Country:US
Mailing Address - Phone:215-356-7586
Mailing Address - Fax:
Practice Address - Street 1:511 W COURTLAND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-1404
Practice Address - Country:US
Practice Address - Phone:215-356-7586
Practice Address - Fax:215-425-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA138160261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health