Provider Demographics
NPI:1689230674
Name:SNUG HARBOR REHABILITATION AND RECOVERY LLC
Entity Type:Organization
Organization Name:SNUG HARBOR REHABILITATION AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-616-8030
Mailing Address - Street 1:4635 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1410
Mailing Address - Country:US
Mailing Address - Phone:814-616-8030
Mailing Address - Fax:814-920-9233
Practice Address - Street 1:4638 E LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1410
Practice Address - Country:US
Practice Address - Phone:814-616-8030
Practice Address - Fax:814-920-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA257088OtherPA DEPARTMENT OF DRUG AND ALCOHOL PROGRAMS