Provider Demographics
NPI:1083172803
Name:MAIN LINE TREATMENT, LLC
Entity Type:Organization
Organization Name:MAIN LINE TREATMENT, LLC
Other - Org Name:MAIN LINE TREATMENT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:610-416-9444
Mailing Address - Street 1:355 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1600
Mailing Address - Country:US
Mailing Address - Phone:610-416-9444
Mailing Address - Fax:610-407-4666
Practice Address - Street 1:1410 RUSSELL RD STE 205
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1200
Practice Address - Country:US
Practice Address - Phone:610-407-4666
Practice Address - Fax:610-407-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder