| Self Inc. | |
|
1425 Arch St Suite 300 Philadelphia PA 19102-1507 | |
| (215) 496-9610 | |
| Not Available |
| Full Name | Self Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1425 Arch St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Nathaniel Robinson (CPO) |
| Authorized Official Contact | 2154969610 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Self Inc. 1425 Arch St Suite 300 Philadelphia PA 19102-1507 | Self Inc. 1425 Arch St Suite 300 Philadelphia PA 19102-1507 Ph: (215) 496-9610 |
| NPI Number | 1164574026 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 08/08/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164574026 | NPI | - | NPPES |
| 350-9 | Medicaid | PA | |
| 375-11 | Medicaid | PA | |
| 350-1 | Medicaid | PA | |
| 350-13 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 807186 (Pennsylvania) | Primary |
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