Provider Demographics
NPI:1700382009
Name:PENNSYLVANIA CALYX RECOVERY PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:PENNSYLVANIA CALYX RECOVERY PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-324-1073
Mailing Address - Street 1:49 E LANCASTER AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3002
Mailing Address - Country:US
Mailing Address - Phone:484-324-1073
Mailing Address - Fax:484-324-1074
Practice Address - Street 1:49 E LANCASTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3002
Practice Address - Country:US
Practice Address - Phone:484-324-1073
Practice Address - Fax:484-324-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder