Provider Demographics
NPI:1184479339
Name:SUSQUEHANNA HEALTH AND WELLNESS
Entity type:Organization
Organization Name:SUSQUEHANNA HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LILLIAN
Authorized Official - Last Name:MOTHERSHED
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-807-6226
Mailing Address - Street 1:4125 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-1647
Mailing Address - Country:US
Mailing Address - Phone:443-807-6226
Mailing Address - Fax:
Practice Address - Street 1:4125 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-1647
Practice Address - Country:US
Practice Address - Phone:443-807-6226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health