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General NPI Number Information
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NPI Number | 1750677696
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Entity Type | Organization
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Legal Business Name | GREATER READING MENTAL HEALTH ALLIANCE
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 1234 PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-2130
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Country | US
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Telephone | 610-775-3000
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Fax | 610-775-4000
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Provider Business Mailing Address
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Address Line | 1234 PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-2130
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Country | US
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Telephone | 610-775-3000
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Fax | 610-775-4000
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Authorized Official
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Title or Position | PEER SUPPORT DIRECTOR
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Name | MR. JOSEPH KOZAK
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Credential |
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Telephone | 610-775-3000
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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 | 261Q00000X
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 261QM0801X
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License Number State | PA
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