Healthcare Provider Details

I. General information

NPI: 1508549155
Provider Name (Legal Business Name): PWS WAYNE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 DEVON PARK DR STE 306
WAYNE PA
19087-1809
US

IV. Provider business mailing address

15 PERLMAN DR STE 120
SPRING VALLEY NY
10977-5281
US

V. Phone/Fax

Practice location:
  • Phone: 610-947-0800
  • Fax: 610-756-2050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MAYER WEBER
Title or Position: PARTNER
Credential: MR.
Phone: 347-374-1767