Healthcare Provider Details

I. General information

NPI: 1720159064
Provider Name (Legal Business Name): VIAQUEST BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 S STATE ST BOX 729
EPHRATA PA
17522-2601
US

IV. Provider business mailing address

525 METRO PL N SUITE 450
DUBLIN OH
43017-5342
US

V. Phone/Fax

Practice location:
  • Phone: 800-441-7345
  • Fax:
Mailing address:
  • Phone: 800-645-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number306820
License Number StatePA

VIII. Authorized Official

Name: MR. RICH JOHNSON
Title or Position: OWNER PRESIDENT
Credential:
Phone: 800-645-9267