Provider Demographics
NPI:1235441742
Name:WATER STREET HEALTH SERVICES
Entity Type:Organization
Organization Name:WATER STREET HEALTH SERVICES
Other - Org Name:WATER STREET RESCUE MISSION MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:717-358-2092
Mailing Address - Street 1:210 S PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-5314
Mailing Address - Country:US
Mailing Address - Phone:717-358-2017
Mailing Address - Fax:717-393-1017
Practice Address - Street 1:210 S PRINCE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-5314
Practice Address - Country:US
Practice Address - Phone:717-358-2017
Practice Address - Fax:717-393-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental