Philadelphia Mental Health Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

123880 Issued in PA

Legal business name

PHILADELPHIA MENTAL HEALTH CLINIC

Practice address

1235 Pine St
Philadelphia, PA 19107-5945

Phone

(215) 735-9379

Fax

(215) 732-8199

NPI assigned

Apr 3, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Allen Anderson

Title

Director, Billing and PC Systems

Phone

(215) 735-9379

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Phi9ladelphia Mental Health Clinic - BHRS Other name

Tax ID family

Phila Mental Health Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Philadelphia Mental Health Clinic

  • Clinic/Center
  • Philadelphia, PA
  • NPI 1760644744
  NPD tax ID
• Philadelphia Mental Health Clinic

  dba Delaware Valley Children's Center

  • Clinic/Center
  • Philadelphia, PA
  • NPI 1780746917
  NPD tax ID

Locations

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184745572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 PINE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075945",
            "telephone_number": "215-735-9379",
            "fax_number": "215-732-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 PINE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075945",
            "telephone_number": "215-735-9379",
            "fax_number": "215-732-8199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA MENTAL HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "DIRECTOR, BILLING AND PC SYSTEMS",
        "authorized_official_telephone_number": "215-735-9379",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "PA",
            "license": "123880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN PAHC",
            "identifier": "265050000",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007279540001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phi9ladelphia Mental Health Clinic - BHRS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.