Healthcare Provider Details

I. General information

NPI: 1235441742
Provider Name (Legal Business Name): WATER STREET HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S PRINCE ST
LANCASTER PA
17603-5314
US

IV. Provider business mailing address

210 S PRINCE ST
LANCASTER PA
17603-5314
US

V. Phone/Fax

Practice location:
  • Phone: 717-358-2017
  • Fax: 717-393-1017
Mailing address:
  • Phone: 717-358-2017
  • Fax: 717-393-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GALE THOMASON
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, BSN
Phone: 717-358-2092