Healthcare Provider Details

I. General information

NPI: 1386201713
Provider Name (Legal Business Name): MOUNTAINS EDGE RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 09/23/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SUGAR HILL RD
UNION DALE PA
18470-7397
US

IV. Provider business mailing address

310 SUGAR HILL RD
UNIONDALE PA
18470
US

V. Phone/Fax

Practice location:
  • Phone: 772-252-1235
  • Fax: 772-252-1235
Mailing address:
  • Phone: 570-679-2459
  • Fax: 570-413-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HALL
Title or Position: CFO
Credential:
Phone: 772-777-0467