Healthcare Provider Details

I. General information

NPI: 1417662446
Provider Name (Legal Business Name): DISCOVERY HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DISCOVERY HOUSE, LLC DBA WILKES-BARRE COMPREHENSIVE TREATMENT CENTER 307 LAIRD STREET
WILKES-BARRE TWP PA
18702
US

IV. Provider business mailing address

6183 PASEO DEL NORTE STE 200
CARLSBAD CA
92011-1155
US

V. Phone/Fax

Practice location:
  • Phone: 570-407-4304
  • Fax: 877-552-0439
Mailing address:
  • Phone: 855-259-2288
  • Fax: 877-552-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: NASSER KHAN, MD
Title or Position: GROUP PRESIDENT
Credential:
Phone: 615-861-6000