Healthcare Provider Details

I. General information

NPI: 1467691774
Provider Name (Legal Business Name): SUPPORTIVE CONCEPTS FOR FAMILIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PENN ST
READING PA
19602-1000
US

IV. Provider business mailing address

200 PENN ST
READING PA
19602-1000
US

V. Phone/Fax

Practice location:
  • Phone: 610-372-7712
  • Fax: 610-373-2398
Mailing address:
  • Phone: 610-372-7712
  • Fax: 610-373-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number216110
License Number StatePA

VIII. Authorized Official

Name: RYAN D. SMITH
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 610-372-7712