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General NPI Number Information
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NPI Number | 1629953732
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Entity Type | Organization
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Legal Business Name | PSYCHEDELIC HEALTHCARE INC
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 2208 QUARRY DR STE 200
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City | WEST LAWN
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State | PA
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Zip | 19609-1158
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Country | US
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Telephone | 610-396-5139
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Fax | 484-509-5141
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Provider Business Mailing Address
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Address Line | 2208 QUARRY DR STE 200
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City | WEST LAWN
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State | PA
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Zip | 19609-1158
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Country | US
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Telephone | 610-396-5139
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Fax | 484-509-5141
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Authorized Official
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Title or Position | MANAGER
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Name | CHAD STEVEN SCHANER
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Credential | EMT-P
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Telephone | 610-396-5139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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