Provider Demographics
NPI:1417412586
Name:RCA MAT PA LLC
Entity Type:Organization
Organization Name:RCA MAT PA LLC
Other - Org Name:DELAWARE COUNTY HEALTHCARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE DIRECTOR, PATIENT ACCOUNT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-994-2968
Mailing Address - Street 1:2701 RENAISSANCE BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2781
Mailing Address - Country:US
Mailing Address - Phone:610-994-2968
Mailing Address - Fax:
Practice Address - Street 1:53 N UNION AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2536
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:2019-02-04
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder