Provider Demographics
NPI:1104334622
Name:FOUNDATIONS WELLNESS CENTER OF PENNSYLVANIA
Entity type:Organization
Organization Name:FOUNDATIONS WELLNESS CENTER OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-812-6852
Mailing Address - Street 1:555 RYAN RUN RD STE A-E
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1716
Mailing Address - Country:US
Mailing Address - Phone:772-812-6852
Mailing Address - Fax:772-494-7271
Practice Address - Street 1:555 RYAN RUN RD STE A-E
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1716
Practice Address - Country:US
Practice Address - Phone:772-812-6852
Practice Address - Fax:772-494-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility