NPIMap

Organization Active NPI

Community Council for Mental Health & Mental Retardation Inc

  • Community/Behavioral Health Agency
  • Philadelphia, PA
National Provider Identifier
1093849986
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
121630 Issued in PA
Legal business name
COMMUNITY COUNCIL FOR MENTAL HEALTH & MENTAL RETARDATION INC
Practice address
4900 Wyalusing Ave
Philadelphia, PA 19131-5127
Phone
(215) 473-7033
Fax
(215) 827-5276
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rekiya Bell
Title
Director of Billing/Credentialing
Phone
(215) 921-3713

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 121630 PA Primary

Addresses

Primary practice location

4900 Wyalusing Ave
Philadelphia, PA 19131-5127

Mailing address

4900 Wyalusing Ave
Philadelphia, PA 19131-5127
Phone (267) 979-4290

Other identifiers 2

IdentifierTypeStateIssuer
1000049600021MedicaidPA
1000049600012MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040621001596 PA Part B Supplier - Clinic/Group Practice 8123003498 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Philadelphia, PA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Community Council36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778457600000",
    "number": "1093849986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 WYALUSING AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191315127",
            "telephone_number": "267-979-4290",
            "fax_number": "215-827-5276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 WYALUSING AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191315127",
            "telephone_number": "215-473-7033",
            "fax_number": "215-827-5276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY COUNCIL FOR MENTAL HEALTH & MENTAL RETARDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "REKIYA",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING/CREDENTIALING",
        "authorized_official_telephone_number": "215-921-3713"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "121630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000049600021",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000049600012",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.