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General NPI Number Information
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NPI Number | 1619821022
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Entity Type | Organization
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Legal Business Name | LUMOS BEHAVIORAL HEALTH FAYETTEVILLE, LLC
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 11302 S MOUNTAIN RD
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City | FAYETTEVILLE
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State | PA
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Zip | 17222-9626
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Country | US
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Telephone | 717-500-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 124 GROVE AVE UNIT 339
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City | CEDARHURST
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State | NY
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Zip | 11516-4014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAWRENCE WEISS
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Credential |
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Telephone | 917-816-5353
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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