Provider Demographics
NPI:1710250196
Name:TUNE-UP NETWORK ENTERPRISES LLC
Entity Type:Organization
Organization Name:TUNE-UP NETWORK ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MT-BC, LPC
Authorized Official - Phone:610-255-1350
Mailing Address - Street 1:1 TREE TOPS RD
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-1028
Mailing Address - Country:US
Mailing Address - Phone:610-255-1350
Mailing Address - Fax:
Practice Address - Street 1:1 TREE TOPS RD
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-1028
Practice Address - Country:US
Practice Address - Phone:610-255-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001972171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018634570003Medicaid