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General NPI Number Information
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NPI Number | 1790638567
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Entity Type | Organization
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Legal Business Name | PROVIVE WELLNESS SCRANTON LLC
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Dates
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Enumeration Date | 02/19/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 1123 CAPOUSE AVE
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City | SCRANTON
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State | PA
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Zip | 18509-2730
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Country | US
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Telephone | 347-374-1767
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Fax |
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Provider Business Mailing Address
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Address Line | 15 PERLMAN DR STE 120
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City | SPRING VALLEY
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State | NY
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Zip | 10977-5281
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Country | US
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Telephone | 347-374-1767
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MAYER WEBER
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Credential |
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Telephone | 347-374-1767
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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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