MEDICARE: PSYCHEDELIC HEALTHCARE 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1629953732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHEDELIC HEALTHCARE INC

Provider Business Mailing Address
First Line	:	2208 QUARRY DR STE 200
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1158
Country	:	US
Telephone Number	:	610-396-5139
Fax Number	:	484-509-5141

Provider Business Practice Location Address
First Line	:	2208 QUARRY DR STE 200
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1158
Country	:	US
Telephone Number	:	610-396-5139
Fax Number	:	484-509-5141

Authorized Official
Title or Position	:	MANAGER
Name	:	CHAD STEVEN SCHANER
Credential	:	EMT-P
Telephone Number	:	610-396-5139

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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