Provider Demographics
NPI:1104200500
Name:BEHAVIORAL WELLNESS AND RECOVERY OF PENNSYLVANIA LLC
Entity Type:Organization
Organization Name:BEHAVIORAL WELLNESS AND RECOVERY OF PENNSYLVANIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-260-7026
Mailing Address - Street 1:704 W NIELDS ST
Mailing Address - Street 2:#9
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4102
Mailing Address - Country:US
Mailing Address - Phone:484-452-3650
Mailing Address - Fax:484-631-0500
Practice Address - Street 1:704 W NIELDS ST
Practice Address - Street 2:#9
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4102
Practice Address - Country:US
Practice Address - Phone:484-452-3650
Practice Address - Fax:484-631-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA157066291U00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No291U00000XLaboratoriesClinical Medical Laboratory