Provider Demographics
NPI:1104689421
Name:INTERSECTIONS WELLNESS LLC
Entity type:Organization
Organization Name:INTERSECTIONS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKYRM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-256-0533
Mailing Address - Street 1:250 INSURANCE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2760
Mailing Address - Country:US
Mailing Address - Phone:330-256-0533
Mailing Address - Fax:
Practice Address - Street 1:250 INSURANCE ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2760
Practice Address - Country:US
Practice Address - Phone:330-256-0533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty