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General NPI Number Information
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NPI Number | 1962553800
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Entity Type | Organization
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Legal Business Name | RE-ENTER, INC.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 3331 POWELTON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2725
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Country | US
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Telephone | 215-222-2770
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Fax | 215-222-3165
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | BIRDSBORO
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State | PA
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Zip | 19508-0007
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Country | US
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Telephone | 215-222-2770
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Fax | 215-222-3165
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VANCE HUDSON
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Credential |
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Telephone | 215-850-9656
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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 | 807245
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 807245
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License Number State | PA
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