Provider Demographics
NPI:1689700551
Name:MEN & WOMEN FOR HUMAN EXCELLENCE, INC.
Entity type:Organization
Organization Name:MEN & WOMEN FOR HUMAN EXCELLENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-769-7045
Mailing Address - Street 1:2603 CECIL B MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-2826
Mailing Address - Country:US
Mailing Address - Phone:215-769-7045
Mailing Address - Fax:215-769-7046
Practice Address - Street 1:2603 CECIL B MOORE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2826
Practice Address - Country:US
Practice Address - Phone:215-769-7045
Practice Address - Fax:215-769-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011438420002OtherMENTAL HEALTH
PA1011438420002OtherDRUG AND ALCOHOL