Provider Demographics
NPI:1457974313
Name:CARELINK COMMUNITY SUPPORT SERVICES OF PENNSYLVANIA INC
Entity Type:Organization
Organization Name:CARELINK COMMUNITY SUPPORT SERVICES OF PENNSYLVANIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-874-1119
Mailing Address - Street 1:106 CHESLEY DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1759
Mailing Address - Country:US
Mailing Address - Phone:610-874-1119
Mailing Address - Fax:610-565-3802
Practice Address - Street 1:614 W BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6812
Practice Address - Country:US
Practice Address - Phone:610-874-1119
Practice Address - Fax:610-565-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health