Basic Information
| Provider Information | |||||||||
| NPI: | 1720072366 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESOURCES FOR HUMAN DEVELOPMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 WISSAHICKON AVE | ||||||||
| Address2: | SUITE 118 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191444248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154384779 | ||||||||
| FaxNumber: | 2152980501 | ||||||||
| Practice Location | |||||||||
| Address1: | 4333 KELLY DR | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191291760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158432580 | ||||||||
| FaxNumber: | 2158434086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | FISHMAN | ||||||||
| AuthorizedOfficialFirstName: | BOB | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICIER | ||||||||
| AuthorizedOfficialTelephone: | 2159510300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.