OrganizationActive
Resources Form Human Development
NPI 1962532945 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Philadelphia, PA
Provider details
- NPI number
- 1962532945
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Adrienne Rotella, Ar Coordinator(215) 951-0300
- License
- 1000017080438 (PA)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 1000017080438 (PA)
Residential Treatment Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3471 Bowman St
Philadelphia, PA 19129-1508
Phone: (215) 387-4288
Fax: (215) 387-4360
Street-level locationGet directions
Mailing address
4700 Wissahickon Ave
Philadelphia, PA 19144-4248
Registry dates
- Enumerated
- 2007-03-07
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.