Provider Demographics
NPI:1235663139
Name:235 W LANCASTER AVENUE OPCO, LLC
Entity Type:Organization
Organization Name:235 W LANCASTER AVENUE OPCO, LLC
Other - Org Name:RECOVERY CENTERS OF AMERICA AT DEVON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-994-2900
Mailing Address - Street 1:2201 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2709
Mailing Address - Country:US
Mailing Address - Phone:610-994-2900
Mailing Address - Fax:
Practice Address - Street 1:RECOVERY CENTERS OF AMERICA AT DEVON
Practice Address - Street 2:235 W LANCASTER AVE
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1560
Practice Address - Country:US
Practice Address - Phone:610-994-2968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health