Healthcare Provider Details

I. General information

NPI: 1356677413
Provider Name (Legal Business Name): BETHESDA FAMILY SERVICE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 BULL RUN XING SUITE ONE
LEWISBURG PA
17837-6725
US

IV. Provider business mailing address

88 BULL RUN XING SUITE ONE
LEWISBURG PA
17837-6725
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-0605
  • Fax: 570-523-0676
Mailing address:
  • Phone: 570-523-0605
  • Fax: 570-523-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DOMINIC P HERBST
Title or Position: PRESIDENT
Credential: M.S.
Phone: 570-523-0605