Provider Demographics
NPI:1073649299
Name:SWATARA FAMILY HEALTH & WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:SWATARA FAMILY HEALTH & WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:717-443-9970
Mailing Address - Street 1:5400 CHAMBERS HILL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2545
Mailing Address - Country:US
Mailing Address - Phone:717-443-9970
Mailing Address - Fax:
Practice Address - Street 1:5400 CHAMBERS HILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3301
Practice Address - Country:US
Practice Address - Phone:717-443-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006571-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty