Provider Demographics
NPI:1740491398
Name:FAMILY ENRICHMENT CENTER PC
Entity type:Organization
Organization Name:FAMILY ENRICHMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-342-4665
Mailing Address - Street 1:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-0735
Mailing Address - Country:US
Mailing Address - Phone:570-342-4665
Mailing Address - Fax:
Practice Address - Street 1:541 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-3000
Practice Address - Country:US
Practice Address - Phone:570-342-4665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016034200004Medicare ID - Type Unspecified