Provider Demographics
NPI:1427786821
Name:WATER GAP WELLNESS RECOVERY LLC
Entity type:Organization
Organization Name:WATER GAP WELLNESS RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHLIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-524-3039
Mailing Address - Street 1:100 PLAZA CT STE D
Mailing Address - Street 2:
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8258
Mailing Address - Country:US
Mailing Address - Phone:203-524-3039
Mailing Address - Fax:
Practice Address - Street 1:526 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9208
Practice Address - Country:US
Practice Address - Phone:203-524-3039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty