NORTHEAST COMMUNITY CENTER FOR MH/MR (NPI# 1073882296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073882296 |
| Entity Type | Organization |
| Organization Name | NORTHEAST COMMUNITY CENTER FOR MH/MR |
| Practice Address |
4641 Roosevelt Blvd Orleans Building Philadelphia PA 19124-2343 |
| Practice Telephone | 2158312800 |
| Enumeration Date | 2011-12-16 |
| Last Update Date | 2011-12-16 |
| Authorized Official Name | HOWARD KAUFMAN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2158312800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 127450 | PA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1000034170063 | 05 | |
| PA | 1000034170061 | 05 | |
| PA | 1000034170072 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073925400 | Northeast Community Center for Mh/mr | Counselor | 4641 Roosevelt Blvd, Orleans Bldg, Philadelphia, PA 19124-2343 | 2014-05-20 |
| 1669883013 | Northeast Community Center for Mh/mr | Counselor | 4641 Roosevelt Blvd, Orleans Bldg, Philadelphia, PA 19124-2343 | 2014-05-19 |
| 1336418573 | Northeast Community Center for Mh/mr | Early Intervention Provider Agency | 4641 Roosevelt Blvd, Orleans Building, Philadelphia, PA 19124-2343 | 2011-12-16 |
| Street Address |
4641 ROOSEVELT BLVD ORLEANS BUILDING |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19124-2343 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710972161 | Katherine B. Frantz | Psychiatry & Neurology | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2005-09-13 |
| 1770109407 | Amy Fisher | Social Worker | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2020-06-18 |
| 1518583426 | Holly Albaugh | Social Worker | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2020-06-17 |
| 1700401809 | Brittany Arnao | Social Worker | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2398 | 2020-06-15 |
| 1255963047 | Kathleen Cuffy | Registered Nurse | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2020-02-10 |
| 1922641620 | Tower Drexel Academic Medical Group LLC | Psychiatry & Neurology | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2019-10-25 |
| 1871153809 | Roya Bina | Psychiatry & Neurology | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2019-06-20 |
| 1427522937 | Path (people Acting To Help), Inc. | Community Based Residential Treatment Facility, Mental Illness | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2019-01-17 |
| 1609355387 | Samantha Diane Coppola | Counselor | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2018-08-13 |
| 1841785136 | Lauren Newman | Social Worker | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2018-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831749308 | William Mark Hanna Sr. | Pharmacist | 4600 Rooselvelt Blvd Bldg G, Philadelphia, PA 19124 | 2019-09-17 |
| 1881256451 | Medical Discovery Systems, LLC | Durable Medical Equipment & Medical Supplies | 5425 Oxford Ave., 5425 Oxford Ave. Suite (3 A), Philadelphia, PA 19124 | 2019-07-03 |
| 1548731391 | Sierra Pinkney | Registered Nurse | 1615 Granite St, Philadelphia, PA 19124 | 2018-12-05 |
| 1922507987 | Xavier Sergio Henriquez | Counselor | 4510 Frankford Avenue 2nd Floor, Philadelphia, PA 19124 | 2018-02-06 |
| 1558881581 | Isabel Cristina Castillo Hernandez | Pediatrics | 4500-10, Apt 201b, Philadelphia, PA 19124 | 2017-06-21 |
| 1952843732 | Patrick Grugan | Social Worker | Roosevelt Boulevard & Adams Avenue, Philadelphia, PA 19124 | 2016-11-10 |
| 1811340482 | Katarzyna Liwski | Psychiatry & Neurology | 4641 Roosevelt Boulevard, E212, Drexel University College of Medicine Friends Hospital, Philadelphia, PA 19124 | 2016-07-19 |
| 1851769327 | Aleka Kostouros | Social Worker | Roosevelt Blvd & Adams Ave, Northeast Community Center for Behavioral Health, Philadelphia, PA 19124 | 2015-09-14 |
| 1407230378 | Sara Bachani | Psychiatry & Neurology | 4641 Roosevelt Blvd, Friends Hospital, Room 231, Philadelphia, PA 19124 | 2015-07-10 |
| 1215327051 | Alyssa Renee Kirk | Counselor | 4500-10 Frankford Ave, 2nd Floor, Philadelphia, PA 19124 | 2015-02-02 |
| Find all providers in zip 19124 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104463736 | Embolden Community Allies | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4000 Gypsy Ln Unit 204, Philadelphia, PA 19129-5405 | 2019-12-02 |
| 1518470624 | Cdig Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1714 Danforth St, Philadelphia, PA 19152-1802 | 2017-11-10 |
| 1699285676 | Antonio Romero | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1045 N Leithgow St, Philadelphia, PA 19123-1420 | 2017-10-04 |
| 1578007795 | Rhonda Hill-sharif | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2932 N Taylor St, Philadelphia, PA 19132-1911 | 2016-12-06 |
| 1588039960 | Holcomb Associates, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4000 Presidential Blvd Apt 1101, Philadelphia, PA 19131-1720 | 2015-12-10 |
| 1205213832 | Serene Services Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1144 N 4th St, Philadelphia, PA 19123-1503 | 2015-05-04 |
| 1982931440 | Vernon Care Living Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 729 E Vernon Rd, Philadelphia, PA 19119-1502 | 2009-11-04 |
| 1578715959 | Transion Stage Three | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5602 Harley Dr Apt 2c, Philadelphia, PA 19143-6264 | 2008-10-16 |
| 1760517205 | Eman Community Living Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 820 E Vernon Rd Fl 2, Philadelphia, PA 19119-1519 | 2007-02-23 |
| 1093995243 | Resources for Human Development | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4700 Wissahickon Ave, Philadelphia, PA 19144-4248 | 2007-11-05 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19124 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.