Provider Demographics
NPI:1538503214
Name:FERN HILL REAL ESTATE LLC
Entity Type:Organization
Organization Name:FERN HILL REAL ESTATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CADC
Authorized Official - Phone:570-851-9664
Mailing Address - Street 1:210 JENNIFER ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-6034
Mailing Address - Country:US
Mailing Address - Phone:570-851-9664
Mailing Address - Fax:
Practice Address - Street 1:210 JENNIFER ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-6034
Practice Address - Country:US
Practice Address - Phone:570-851-9664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty