Provider Demographics
NPI:1417146887
Name:DYNAMIC RECOVERY AND WELLNESS LLC
Entity Type:Organization
Organization Name:DYNAMIC RECOVERY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SENYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-862-7317
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-0360
Mailing Address - Country:US
Mailing Address - Phone:215-862-7317
Mailing Address - Fax:215-862-0473
Practice Address - Street 1:18 W STATE ST
Practice Address - Street 2:SUITE 225
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4240
Practice Address - Country:US
Practice Address - Phone:215-862-7317
Practice Address - Fax:215-862-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA130600320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness