Provider Demographics
NPI:1215277983
Name:MATERNAL CHILD CONSORTIUM, INC.
Entity type:Organization
Organization Name:MATERNAL CHILD CONSORTIUM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-525-7008
Mailing Address - Street 1:800 CLARMONT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5705
Mailing Address - Country:US
Mailing Address - Phone:267-525-7000
Mailing Address - Fax:267-525-7010
Practice Address - Street 1:4319 HULMEVILLE RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3838
Practice Address - Country:US
Practice Address - Phone:267-525-7000
Practice Address - Fax:267-525-7010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATERNAL CHILD CONSORTIUM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA112720251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007762890003Medicaid