Provider Demographics
NPI:1386016939
Name:WALLS OF REFUGE COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:WALLS OF REFUGE COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:267-348-9916
Mailing Address - Street 1:527 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1511
Mailing Address - Country:US
Mailing Address - Phone:267-348-9916
Mailing Address - Fax:
Practice Address - Street 1:527 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1511
Practice Address - Country:US
Practice Address - Phone:267-348-9916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAQW53141261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)