NPIMap

Organization Active NPI

West Philadelphia Community MH Consortium Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1699892935
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
128620 Issued in PA
Legal business name
WEST PHILADELPHIA COMMUNITY MH CONSORTIUM INC.
Practice address
4300 Westminster Ave
Philadelphia, PA 19104-1308
Phone
(215) 596-8100
Fax
(215) 382-4405
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. John F White Jr.
Title
President Ceo
Phone
(215) 596-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 128620 PA Primary

Addresses

Primary practice location

4300 Westminster Ave
Philadelphia, PA 19104-1308

Mailing address

3801 Market St
Suite 201
Philadelphia, PA 19104-3153
Phone (215) 596-8100

Other identifiers 1

IdentifierTypeStateIssuer
1007155230064MedicaidPA

Other names 1

  • The Consortium Inc. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
The Consortium Inc35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699892935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 MARKET ST",
            "address_2": "SUITE 201",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043153",
            "telephone_number": "215-596-8100",
            "fax_number": "215-382-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 WESTMINSTER AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191041308",
            "telephone_number": "215-596-8100",
            "fax_number": "215-382-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST PHILADELPHIA COMMUNITY MH CONSORTIUM INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT  CEO",
        "authorized_official_telephone_number": "215-596-8100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "PA",
            "license": "128620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007155230064",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Consortium Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 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.