Provider Demographics
NPI:1508218801
Name:THE BODHANA GROUP INCORPORATED
Entity Type:Organization
Organization Name:THE BODHANA GROUP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BERKENSTOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MHS
Authorized Official - Phone:717-615-5803
Mailing Address - Street 1:448 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2102
Mailing Address - Country:US
Mailing Address - Phone:717-615-5803
Mailing Address - Fax:
Practice Address - Street 1:237 N PRINCE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4062
Practice Address - Country:US
Practice Address - Phone:717-224-1273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty