Provider Demographics
NPI:1669993366
Name:KITHS INTEGRATED AND TARGETED HUMAN SERVICES
Entity type:Organization
Organization Name:KITHS INTEGRATED AND TARGETED HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:KITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MFT
Authorized Official - Phone:215-278-6222
Mailing Address - Street 1:5812 NEWTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1129
Mailing Address - Country:US
Mailing Address - Phone:215-278-6222
Mailing Address - Fax:215-914-6961
Practice Address - Street 1:4911 OLD YORK RD FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2704
Practice Address - Country:US
Practice Address - Phone:215-278-6222
Practice Address - Fax:215-914-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========Medicaid