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NPI Code Detail

MEDICARE: COMMONWEALTH CLINICAL GROUP, INC.

MEDICARE: COMMONWEALTH CLINICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215558382
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMONWEALTH CLINICAL GROUP, INC.
Provider Business Mailing Address
First Line : 41 E ORANGE ST
Second Line :
City : LANCASTER
State : PA
Zip : 17602-2846
Country : US
Telephone Number : 717-393-3900
Fax Number : 717-393-7900
Provider Business Practice Location Address
First Line : 41 E ORANGE ST
Second Line :
City : LANCASTER
State : PA
Zip : 17602-2846
Country : US
Telephone Number : 717-393-3900
Fax Number : 717-393-7900
Authorized Official
Title or Position : BILLING COORDINATOR
Name : STACIE BASHAM
Credential :
Telephone Number : 717-393-3900
Provider Enumeration Date : 04/30/2020
Last Update Date : 09/15/2021

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Directions to “COMMONWEALTH CLINICAL GROUP, INC. ” Practice Location

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