Provider Demographics
NPI:1083030936
Name:LAUREL WELLNESS CENTERS
Entity Type:Organization
Organization Name:LAUREL WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:814-692-4954
Mailing Address - Street 1:134 JACOBS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-9240
Mailing Address - Country:US
Mailing Address - Phone:814-692-4954
Mailing Address - Fax:814-692-4485
Practice Address - Street 1:85 BEAVER DRIVE
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801
Practice Address - Country:US
Practice Address - Phone:814-503-8055
Practice Address - Fax:814-503-8145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA177110261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder