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General NPI Number Information
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NPI Number | 1861920936
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Entity Type | Organization
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Legal Business Name | COLONIAL PARK INTENSIVE OUTPATIENT PROGRAM, LLC
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 55 S PROGRESS AVE
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City | HARRISBURG
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State | PA
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Zip | 17109-4623
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Country | US
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Telephone | 717-991-4755
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Fax | 717-724-5530
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Provider Business Mailing Address
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Address Line | 42 NW 3RD AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-2622
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Country | US
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Telephone | 717-991-4755
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Fax | 717-724-5530
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Authorized Official
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Title or Position | OWNER
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Name | JOHN LAUS
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Credential |
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Telephone | 717-991-4755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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