NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH-MENTAL RETARDATION INC. (NPI# 1306210703) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306210703 |
| Entity Type | Organization |
| Organization Name | NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH-MENTAL RETARDATION INC. |
| Practice Address |
4641 Roosevelt Blvd Orleans Bldg Philadelphia PA 19124-2343 |
| Practice Telephone | 2158312800 |
| Practice Fax Number | 2158312929 |
| Mailing Telephone | 2158312800 |
| Mailing Fax Number | 2158312929 |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2015-11-23 |
| Authorized Official Name | DAVID COMO (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2158312828 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 124560 | PA | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225693328 | Northeast Community Center for Mental Health-mental Retardation Inc. | Clinic/Center | 4371 Waln St, Philadelphia, PA 19124-4010 | 2019-05-03 |
| 1457896565 | Northeast Community Center for Mental Health-mental Retardation Inc. | Community Based Residential Treatment Facility, Mental Illness | 4641 Roosevelt Blvd, Philadelphia, PA 19124-2343 | 2016-12-28 |
| 1396119798 | Northeast Community Center for Mental Health-mental Retardation Inc. | Community Based Residential Treatment Facility, Mental Illness | 4641 Roosevelt Blvd, Orleans Building, Philadelphia, PA 19124-2343 | 2015-11-23 |
| Street Address |
4641 ROOSEVELT BLVD ORLEANS BLDG |
| 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 | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457892283 | Evangelical Alumni Inc. | Community Based Residential Treatment Facility, Mental Illness | 3232 N 33rd St, 3232 N 33rd St, Philadelphia, PA 19129-1202 | 2017-03-13 |
| 1932645108 | Elwyn | Community Based Residential Treatment Facility, Mental Illness | 5218 Germantown Ave, Philadelphia, PA 19144-2347 | 2017-01-12 |
| 1639536949 | Path (people Acting To Help) | Community Based Residential Treatment Facility, Mental Illness | 8429 Castor Ave, Philadelphia, PA 19152-1903 | 2016-01-19 |
| 1821453150 | Community Outreach Program | Community Based Residential Treatment Facility, Mental Illness | 1311 N 52nd St, Philadelphia, PA 19131-4412 | 2015-12-31 |
| 1154786564 | Path (people Acting To Help), Inc. | Community Based Residential Treatment Facility, Mental Illness | 716 Rhawn St, Philadelphia, PA 19111-2554 | 2015-12-30 |
| 1427413863 | Path (people Acting To Help), Inc. | Community Based Residential Treatment Facility, Mental Illness | 6818 Ditman St, Philadelphia, PA 19135-2204 | 2015-12-30 |
| 1124483557 | Path (people Acting To Help), Inc. | Community Based Residential Treatment Facility, Mental Illness | 920 Griffith St, Philadelphia, PA 19111-2615 | 2015-12-30 |
| 1922463355 | Path (people Acting To Help), Inc. | Community Based Residential Treatment Facility, Mental Illness | 2340 Benson St # 1, Philadelphia, PA 19152-2504 | 2015-12-30 |
| 1104281831 | Path (people Acting To Help), Inc. | Community Based Residential Treatment Facility, Mental Illness | 3131 Willits Rd, Philadelphia, PA 19114-3816 | 2015-12-23 |
| 1063895571 | James Nathaniel | Community Based Residential Treatment Facility, Mental Illness | 9 W Phil Ellena St, Philadelphia, PA 19119-2725 | 2015-07-01 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19124 |
Please comment or provide details below to improve the information on NORTHEAST COMMUNITY CENTER FOR MENTAL HEALTH-MENTAL RETARDATION INC..
| 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.