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General NPI Number Information
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NPI Number | 1104200500
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL WELLNESS AND RECOVERY OF PENNSYLVANIA LLC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | 704 W NIELDS ST #9
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City | WEST CHESTER
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State | PA
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Zip | 19382-4102
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Country | US
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Telephone | 484-452-3650
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Fax | 484-631-0500
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Provider Business Mailing Address
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Address Line | 704 W NIELDS ST #9
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City | WEST CHESTER
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State | PA
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Zip | 19382-4102
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Country | US
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Telephone | 484-452-3650
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Fax | 484-631-0500
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Authorized Official
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Title or Position | CFO
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Name | DR. GEORGE CHU
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Credential | PH.D.
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Telephone | 215-260-7026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 157066
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 157066
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License Number State | PA
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