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General NPI Number Information
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NPI Number | 1366008260
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Entity Type | Organization
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Legal Business Name | LTC TREATMENT CENTER INC
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 7712 BUIST AVE APT B
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City | PHILADELPHIA
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State | PA
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Zip | 19153-1705
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Country | US
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Telephone | 215-282-6640
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Fax |
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Provider Business Mailing Address
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Address Line | 3720 SPRUCE ST # 318
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4115
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Country | US
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Telephone | 215-282-6640
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MATTHEW RANWWEILER
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Credential |
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Telephone | 215-282-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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