Healthcare Provider Details

I. General information

NPI: 1710500590
Provider Name (Legal Business Name): BERKS COUNTY RECOVERY TRANSITIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 INGOT DR
BLANDON PA
19510-9639
US

IV. Provider business mailing address

13 INGOT DR
BLANDON PA
19510-9639
US

V. Phone/Fax

Practice location:
  • Phone: 215-275-8962
  • Fax: 484-624-3280
Mailing address:
  • Phone: 215-275-8962
  • Fax: 484-624-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROIN R LAYSEARS-SMITH
Title or Position: CEO
Credential:
Phone: 215-275-8962