Provider Demographics
NPI:1306090592
Name:TRANSITION PHASE III
Entity type:Organization
Organization Name:TRANSITION PHASE III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-878-2052
Mailing Address - Street 1:3900 CITY AVE
Mailing Address - Street 2:MADISON BUILDING, SUITE 1207
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2908
Mailing Address - Country:US
Mailing Address - Phone:215-878-3052
Mailing Address - Fax:
Practice Address - Street 1:3900 CITY AVE
Practice Address - Street 2:MADISON BUILDING, SUITE 1207
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2908
Practice Address - Country:US
Practice Address - Phone:215-878-3052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization