Provider Demographics
NPI:1013532266
Name:MARCUS SELF DISCOVERY GROUP LLC
Entity Type:Organization
Organization Name:MARCUS SELF DISCOVERY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:FALWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-840-6929
Mailing Address - Street 1:2203 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4323
Mailing Address - Country:US
Mailing Address - Phone:484-840-6929
Mailing Address - Fax:
Practice Address - Street 1:2203 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4323
Practice Address - Country:US
Practice Address - Phone:484-840-6929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty