| Restoration And Wellness Llc | |
|
223 Summit Ave Fort Washington PA 19034-1525 | |
| (844) 448-5872 | |
| (267) 996-3983 |
| Full Name | Restoration And Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 223 Summit Ave, Fort Washington, Pennsylvania |
| Authorized Official Name and Position | Matthew Mccullough (SVP, CCO) |
| Authorized Official Contact | 6098288061 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restoration And Wellness Llc 223 Summit Ave Fort Washington PA 19034-1525 Ph: (844) 448-5872 | Restoration And Wellness Llc 223 Summit Ave Fort Washington PA 19034-1525 Ph: (844) 448-5872 |
| NPI Number | 1770172033 |
|---|---|
| Provider Enumeration Date | 01/12/2021 |
| Last Update Date | 07/08/2021 |
| Certification Date | 07/08/2021 |
| Medicare PECOS PAC ID | 7618353426 |
|---|---|
| Medicare Enrollment ID | O20221003000684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770172033 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Sandra K Wiley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912911306 PECOS PAC ID: 8820165830 Enrollment ID: I20080917000202 |
| Provider Name | Griszel Long |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255739892 PECOS PAC ID: 5597045419 Enrollment ID: I20161212002312 |
| Provider Name | Kelly A Stangl Meddaugh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265573596 PECOS PAC ID: 9739434028 Enrollment ID: I20180608000801 |
| Provider Name | Daniel N Pistone |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962405084 PECOS PAC ID: 2062490113 Enrollment ID: I20230613002763 |
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