Healthcare Provider Details

I. General information

NPI: 1710364385
Provider Name (Legal Business Name): PENNREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S MAIN ST
ALLENTOWN NJ
08501-1610
US

IV. Provider business mailing address

18 S MAIN ST
ALLENTOWN NJ
08501-1610
US

V. Phone/Fax

Practice location:
  • Phone: 267-559-1152
  • Fax:
Mailing address:
  • Phone: 215-409-5519
  • Fax: 609-259-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL ODELL
Title or Position: CEO
Credential: MED
Phone: 215-409-5519