Healthcare Provider Details

I. General information

NPI: 1811312283
Provider Name (Legal Business Name): EQUI-LIBRIUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 FEHR RD
NAZARETH PA
18064-9153
US

IV. Provider business mailing address

524 FEHR RD
NAZARETH PA
18064-9153
US

V. Phone/Fax

Practice location:
  • Phone: 610-365-2266
  • Fax: 610-365-2263
Mailing address:
  • Phone: 610-365-2266
  • Fax: 610-365-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. POLLY BESTE
Title or Position: CHAIRMAN
Credential:
Phone: 610-365-2266