Provider Demographics
NPI:1235408014
Name:COMMONWEALTH BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES, LLC
Entity Type:Organization
Organization Name:COMMONWEALTH BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CULBRETH
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:267-275-6812
Mailing Address - Street 1:612 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-5502
Mailing Address - Country:US
Mailing Address - Phone:267-275-6812
Mailing Address - Fax:804-658-0335
Practice Address - Street 1:447 S PRINCE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-5657
Practice Address - Country:US
Practice Address - Phone:267-275-6812
Practice Address - Fax:804-658-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health