Provider Demographics
NPI:1376846261
Name:HEALTHQWEST LLC
Entity Type:Organization
Organization Name:HEALTHQWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF CONTRACT MGMT
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-533-8762
Mailing Address - Street 1:1317 ROUTE 73 STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2202
Mailing Address - Country:US
Mailing Address - Phone:856-439-6111
Mailing Address - Fax:
Practice Address - Street 1:607 RUSSELL PKWY STE A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7690
Practice Address - Country:US
Practice Address - Phone:478-225-9860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHOP000044251S00000X
261QM2800X, 261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care