Healthcare Provider Details

I. General information

NPI: 1427786821
Provider Name (Legal Business Name): WATER GAP WELLNESS RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 INDEPENDENCE RD
E STROUDSBURG PA
18301-9208
US

IV. Provider business mailing address

100 PLAZA CT STE D
E STROUDSBURG PA
18301-8258
US

V. Phone/Fax

Practice location:
  • Phone: 203-524-3039
  • Fax:
Mailing address:
  • Phone: 203-524-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH A SCHLIM
Title or Position: CEO
Credential:
Phone: 203-524-3039