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18336 Route 522 Beavertown PA 17813-9004 | |
| (570) 658-7383 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 18336 Route 522, Beavertown, Pennsylvania |
| Authorized Official Name and Position | James Robert Desanto (CORPORATE CLINICAL DIRECTOR) |
| Authorized Official Contact | 5703220520 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
800 W 4th St Suite G-01 Williamsport PA 17701-5895 Ph: (570) 322-0520 | 18336 Route 522 Beavertown PA 17813-9004 Ph: (570) 658-7383 |
| NPI Number | 1790006765 |
|---|---|
| Provider Enumeration Date | 06/14/2010 |
| Last Update Date | 06/14/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790006765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 557054 (Pennsylvania) | Primary |