Healthcare Provider Details

I. General information

NPI: 1932846367
Provider Name (Legal Business Name): SAEGERTOWN RECOVERY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 ERIE ST
SAEGERTOWN PA
16433-5003
US

IV. Provider business mailing address

707 ERIE ST
SAEGERTOWN PA
16433-5003
US

V. Phone/Fax

Practice location:
  • Phone: 814-763-2010
  • Fax: 814-763-5535
Mailing address:
  • Phone: 814-763-2010
  • Fax: 814-763-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JILL C MILLER
Title or Position: OWNER
Credential: DO
Phone: 814-763-2010