Healthcare Provider Details

I. General information

NPI: 1891559522
Provider Name (Legal Business Name): 717 HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 LITITZ PIKE
LANCASTER PA
17601-6534
US

IV. Provider business mailing address

1604 LITITZ PIKE
LANCASTER PA
17601-6534
US

V. Phone/Fax

Practice location:
  • Phone: 717-818-5462
  • Fax:
Mailing address:
  • Phone: 717-818-5462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA BRUNNER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 717-818-5462