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General NPI Number Information
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NPI Number | 1689505398
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Entity Type | Organization
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Legal Business Name | SG HEALTH CORPORATION
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Dates
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Enumeration Date | 05/29/2026
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Last Update Date | 05/29/2026
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Provider Practice Location Address
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Address Line | 116 S MAIN ST
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City | WILKES BARRE
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State | PA
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Zip | 18701-1606
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Country | US
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Telephone | 570-905-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 2 W NORTHAMPTON ST
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City | WILKES BARRE
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State | PA
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Zip | 18701-1708
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Country | US
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Telephone | 570-905-3322
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | LAKE RYAN GEMZIK
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Credential |
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Telephone | 570-905-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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