Provider Demographics
NPI:1649021924
Name:PEERSTAR SUPPORTIVE CONCEPTS
Entity type:Organization
Organization Name:PEERSTAR SUPPORTIVE CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NULTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-262-0025
Mailing Address - Street 1:210 COLLEGE PARK PLAZA
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2833
Mailing Address - Country:US
Mailing Address - Phone:814-266-1491
Mailing Address - Fax:814-266-1548
Practice Address - Street 1:3929 PERKIOMEN AVENUE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2718
Practice Address - Country:US
Practice Address - Phone:888-733-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health