Healthcare Provider Details

I. General information

NPI: 1174147797
Provider Name (Legal Business Name): ACHIEVE SIGNATURE REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE KIRKLAND VILLAGE CIR
BETHLEHEM PA
18017
US

IV. Provider business mailing address

1 TRINITY DR E STE 201
DILLSBURG PA
17019-8522
US

V. Phone/Fax

Practice location:
  • Phone: 610-691-4500
  • Fax: 610-691-4541
Mailing address:
  • Phone: 717-502-8840
  • Fax: 717-502-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES BERNARDO
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 717-502-8840