Provider Demographics
NPI: | 1013900232 |
---|---|
Name: | REMED RECOVERY CARE CENTERS |
Entity Type: | Organization |
Organization Name: | REMED RECOVERY CARE CENTERS |
Other - Org Name: | REMED |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | PRESIDENT & CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CHARLES |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | MCCARTNEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 484-595-9300 |
Mailing Address - Street 1: | 16 INDUSTRIAL BLVD |
Mailing Address - Street 2: | SUITE 203 |
Mailing Address - City: | PAOLI |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19301-1609 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 484-595-9300 |
Mailing Address - Fax: | 484-595-0377 |
Practice Address - Street 1: | 16 INDUSTRIAL BLVD |
Practice Address - Street 2: | SUITE 203 |
Practice Address - City: | PAOLI |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19301-1609 |
Practice Address - Country: | US |
Practice Address - Phone: | 484-595-9300 |
Practice Address - Fax: | 484-595-0377 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-08-23 |
Last Update Date: | 2019-01-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | 103G00000X, 103T00000X, 103TB0200X, 103TP2701X, 103TR0400X, 171M00000X, 208100000X, 2251N0400X, 225XN1300X, 235Z00000X, 261QR0400X, 320700000X, 320800000X, 320900000X, 385H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Multi-Specialty |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Multi-Specialty |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | Group - Multi-Specialty | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | Group - Multi-Specialty | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Multi-Specialty | |
No | 385H00000X | Respite Care Facility | Respite Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 1006806890008 | Medicaid |