Provider Demographics
NPI:1295614899
Name:FAVOR LAUREL HIGHLANDS
Entity type:Organization
Organization Name:FAVOR LAUREL HIGHLANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RILOGIO
Authorized Official - Suffix:
Authorized Official - Credentials:CRS, CPS, CCHW
Authorized Official - Phone:814-659-7410
Mailing Address - Street 1:226 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-2310
Mailing Address - Country:US
Mailing Address - Phone:814-659-7410
Mailing Address - Fax:
Practice Address - Street 1:226 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-2310
Practice Address - Country:US
Practice Address - Phone:814-659-7410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty