Healthcare Provider Details

I. General information

NPI: 1760118889
Provider Name (Legal Business Name): ROOT TO RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 HAUCK RD
GREEN LANE PA
18054-9587
US

IV. Provider business mailing address

2852 HAUCK RD
GREEN LANE PA
18054-9587
US

V. Phone/Fax

Practice location:
  • Phone: 717-377-4846
  • Fax:
Mailing address:
  • Phone: 717-377-4846
  • Fax:

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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA SNYDER
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 717-377-4846