Healthcare Provider Details

I. General information

NPI: 1043785405
Provider Name (Legal Business Name): ENDLESS MOUNTAINS EXTENDED CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 LITHIA VALLEY RD
FACTORYVILLE PA
18419-7949
US

IV. Provider business mailing address

1042 LITHIA VALLEY RD
FACTORYVILLE PA
18419-7949
US

V. Phone/Fax

Practice location:
  • Phone: 570-219-4401
  • Fax:
Mailing address:
  • Phone: 570-219-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. ARIANNE SCHELLER
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: PHD., LPC
Phone: 570-219-4401