Healthcare Provider Details

I. General information

NPI: 1679393292
Provider Name (Legal Business Name): CDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 COMMUNITY WAY
LANCASTER PA
17603-2329
US

IV. Provider business mailing address

1400 VETERANS HWY
LEVITTOWN PA
19056-2115
US

V. Phone/Fax

Practice location:
  • Phone: 888-755-7227
  • Fax:
Mailing address:
  • Phone: 267-234-7886
  • Fax: 267-953-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORI DUMONT
Title or Position: CFO
Credential:
Phone: 267-234-7886