| NPI | 1528310604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELENA PLATONOVA Director Of Finance 215-464-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261Q00000X (Licence: PA 807427) |
| 261QM2800X Clinic/Center, Methadone Clinic (Licence: PA 807427) | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2019-12-23 |