Provider Demographics
NPI:1053088336
Name:EPIPHANY WELLNESS
Entity Type:Organization
Organization Name:EPIPHANY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO FOUNDER/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-526-8093
Mailing Address - Street 1:25 BEECHNUT LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3806
Mailing Address - Country:US
Mailing Address - Phone:215-526-8093
Mailing Address - Fax:
Practice Address - Street 1:461 ROUTE 168
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-1457
Practice Address - Country:US
Practice Address - Phone:215-526-8093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder