MEDICARE: RE-ENTER, INC.

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	324500000X	Substance Abuse Rehabilitation Facility	807245	PA
2	251S00000X	Community/Behavioral Health Agency	807245	PA

General Provider Information

NPI Number	:	1962553800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RE-ENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 7
Second Line	:
City	:	BIRDSBORO
State	:	PA
Zip	:	19508-0007
Country	:	US
Telephone Number	:	215-222-2770
Fax Number	:	215-222-3165

Provider Business Practice Location Address
First Line	:	3331 POWELTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2725
Country	:	US
Telephone Number	:	215-222-2770
Fax Number	:	215-222-3165

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	VANCE HUDSON
Credential	:
Telephone Number	:	215-850-9656

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	02/24/2016

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