Basic Information
| Provider Information | |||||||||
| NPI: | 1023610961 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESOUCES FOR HUMAN DEVELOPMENT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 WISSAHICKON AVE STE 126 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191444248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679849775 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4700 WISSAHICKON AVE STE 126 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191444248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155083300 | ||||||||
| FaxNumber: | 2155083210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2020 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOLLOMAN | ||||||||
| AuthorizedOfficialFirstName: | KAYLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | QUALITY ASSURANCE ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 2679849775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 100001708 | 05 | PA | MEDICAID |