| NPI | 1487084265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM RUSH Credentialing Specialist 610-834-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 0904007651) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |