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General NPI Number Information
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NPI Number | 1053088336
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Entity Type | Organization
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Legal Business Name | EPIPHANY WELLNESS
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 461 ROUTE 168
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City | BLACKWOOD
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State | NJ
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Zip | 08012-1457
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Country | US
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Telephone | 215-526-8093
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Fax |
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Provider Business Mailing Address
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Address Line | 25 BEECHNUT LN
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City | WILLINGBORO
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State | NJ
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Zip | 08046-3806
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Country | US
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Telephone | 215-526-8093
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Fax |
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Authorized Official
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Title or Position | CO FOUNDER/COO
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Name | MR. SHAWN MCBRIEN
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Credential |
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Telephone | 215-526-8093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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