Basic Information
| Provider Information | |||||||||
| NPI: | 1558553271 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CITYWIDE COMMUNITY COUNSELING SERVICE INK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 537 E ALLEGHENY AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191342328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152919500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 537 E ALLEGHENY AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191342328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152919500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2007 | ||||||||
| LastUpdateDate: | 08/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | ORLANDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2152919500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 129420 | PA | Y | Agencies | Community/Behavioral Health |
No ID Information.