Basic Information
| Provider Information | |||||||||
| NPI: | 1063577989 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESOURCES FOR HUMAN DEVELOPMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 WISSAHICKON AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191444248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159510300 | ||||||||
| FaxNumber: | 2159510312 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191242117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709920879 | ||||||||
| FaxNumber: | 5799929410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROTELLA | ||||||||
| AuthorizedOfficialFirstName: | ADRIENNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AR COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2159510300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 324500000X | 1000017080191 | PA | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1000017080191 | 05 | PA | MEDICAID |