Provider Demographics
NPI:1558858969
Name:SUPREME WELLNESS RECOVERY LLC
Entity Type:Organization
Organization Name:SUPREME WELLNESS RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-874-3636
Mailing Address - Street 1:603 CORPORATE DR W
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8013
Mailing Address - Country:US
Mailing Address - Phone:215-874-3636
Mailing Address - Fax:
Practice Address - Street 1:603 CORPORATE DR W
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8013
Practice Address - Country:US
Practice Address - Phone:215-874-3636
Practice Address - Fax:215-910-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder