Provider Demographics
NPI:1285099598
Name:WEST PHILA COMMUNITY MENTAL HEALTH CONSORTIUM, INC
Entity type:Organization
Organization Name:WEST PHILA COMMUNITY MENTAL HEALTH CONSORTIUM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-596-8100
Mailing Address - Street 1:3751 ISLAND AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-3237
Mailing Address - Country:US
Mailing Address - Phone:215-596-8100
Mailing Address - Fax:215-382-0511
Practice Address - Street 1:5205 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2626
Practice Address - Country:US
Practice Address - Phone:215-596-8100
Practice Address - Fax:215-382-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA195570320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness