Provider Demographics
NPI:1194889782
Name:LIVENGRIN FOUNDATION, INC.
Entity type:Organization
Organization Name:LIVENGRIN FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BLENK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-638-5200
Mailing Address - Street 1:4833 HULMEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3023
Mailing Address - Country:US
Mailing Address - Phone:215-638-5200
Mailing Address - Fax:215-638-2603
Practice Address - Street 1:4833 HULMEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3023
Practice Address - Country:US
Practice Address - Phone:215-638-5200
Practice Address - Fax:215-638-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 251S00000X, 261QR0405X
PA261QR0405X
PA093121324500000X
PA807337324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007278650019Medicaid