Provider Demographics
NPI:1013038249
Name:WHITE DEER RUN, LLC
Entity Type:Organization
Organization Name:WHITE DEER RUN, LLC
Other - Org Name:WHITE DEER RUN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:5972 SUSQUEHANNA TRL
Mailing Address - Street 2:
Mailing Address - City:TURBOTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17772-8555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5972 SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:TURBOTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17772-8555
Practice Address - Country:US
Practice Address - Phone:570-649-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YA0400X
251S00000X, 282N00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No282N00000XHospitalsGeneral Acute Care Hospital
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100756787Medicaid