Provider Demographics
NPI:1790234235
Name:WHITE DEER RUN LLC
Entity Type:Organization
Organization Name:WHITE DEER RUN LLC
Other - Org Name:THE HOPE PROGRAM OF COVE FORGE AT ROBINSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-873-2131
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-1740
Mailing Address - Country:US
Mailing Address - Phone:570-538-3302
Mailing Address - Fax:570-538-3642
Practice Address - Street 1:100 RYAN CT
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1310
Practice Address - Country:US
Practice Address - Phone:570-538-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center