Provider Demographics
NPI:1770900755
Name:CLINICA BIENESTAR
Entity type:Organization
Organization Name:CLINICA BIENESTAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-985-4448
Mailing Address - Street 1:1233 LOCUST ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5453
Mailing Address - Country:US
Mailing Address - Phone:215-985-4448
Mailing Address - Fax:215-985-4952
Practice Address - Street 1:166 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3849
Practice Address - Country:US
Practice Address - Phone:215-790-1788
Practice Address - Fax:215-732-5490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILADELPHIA FIGHT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service