Provider Demographics
NPI:1790214922
Name:KITHS INTEGRATED AND TARGETED HUMAN SERVICES
Entity type:Organization
Organization Name:KITHS INTEGRATED AND TARGETED HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NARY
Authorized Official - Middle Name:PREAP
Authorized Official - Last Name:KITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-278-6222
Mailing Address - Street 1:768 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3896
Mailing Address - Country:US
Mailing Address - Phone:215-760-2136
Mailing Address - Fax:
Practice Address - Street 1:4923 OLD YORK RD FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2763
Practice Address - Country:US
Practice Address - Phone:215-278-6222
Practice Address - Fax:215-914-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-10
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========Medicaid