Provider Demographics
NPI:1871007286
Name:PENNREACH
Entity Type:Organization
Organization Name:PENNREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-475-2401
Mailing Address - Street 1:18 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1610
Mailing Address - Country:US
Mailing Address - Phone:732-963-4523
Mailing Address - Fax:609-259-4120
Practice Address - Street 1:43 PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:732-963-4523
Practice Address - Fax:609-259-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities