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General NPI Number Information
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NPI Number | 1093986424
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Entity Type | Organization
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Legal Business Name | CYWA
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 423 E LINCOLN HWY
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City | COATESVILLE
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State | PA
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Zip | 19320-3411
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Country | US
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Telephone | 610-384-9591
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Fax | 610-384-9635
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Provider Business Mailing Address
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Address Line | 423 E LINCOLN HWY
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City | COATESVILLE
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State | PA
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Zip | 19320-3411
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Country | US
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Telephone | 610-384-9591
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Fax | 610-384-9635
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MIRAM WEALER
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Credential |
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Telephone | 610-384-9591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 157041
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License Number State | PA
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