Provider Demographics
NPI:1437713591
Name:FOSTER HILL WELLNESS LLC
Entity Type:Organization
Organization Name:FOSTER HILL WELLNESS LLC
Other - Org Name:MALIBU WELLNESS RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CARE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BENWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-296-7281
Mailing Address - Street 1:351 FOSTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-6580
Mailing Address - Country:US
Mailing Address - Phone:570-212-0428
Mailing Address - Fax:
Practice Address - Street 1:351 FOSTER HILL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-6580
Practice Address - Country:US
Practice Address - Phone:570-212-0428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service