MEDICARE: EMBRACE HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	OS009647L	PA

General Provider Information

NPI Number	:	1447607536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACE HEALTH, LLC

Provider Business Mailing Address
First Line	:	310 STOKE PARK RD
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-9429
Country	:	US
Telephone Number	:	484-821-3688
Fax Number	:	610-625-0089

Provider Business Practice Location Address
First Line	:	310 STOKE PARK RD
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-9429
Country	:	US
Telephone Number	:	484-821-3688
Fax Number	:	610-625-0089

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	STACI BOTWIN MULCAHY
Credential	:	D.O.
Telephone Number	:	484-821-3688

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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