Healthcare Provider Details

I. General information

NPI: 1104780303
Provider Name (Legal Business Name): PENNREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MIDDLESEX AVE
METUCHEN NJ
08840-1520
US

IV. Provider business mailing address

18 S MAIN ST
ALLENTOWN NJ
08501-1610
US

V. Phone/Fax

Practice location:
  • Phone: 215-409-5519
  • Fax: 609-259-4120
Mailing address:
  • Phone: 215-409-5519
  • Fax: 609-259-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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