Provider Demographics
NPI:1609510536
Name:IMELA HEALING CENTER, LLC
Entity Type:Organization
Organization Name:IMELA HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-574-5606
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:COBURN
Mailing Address - State:PA
Mailing Address - Zip Code:16832-0141
Mailing Address - Country:US
Mailing Address - Phone:814-574-5606
Mailing Address - Fax:
Practice Address - Street 1:104 NORTH ST
Practice Address - Street 2:
Practice Address - City:MILLHEIM
Practice Address - State:PA
Practice Address - Zip Code:16854-9622
Practice Address - Country:US
Practice Address - Phone:814-574-5606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty