Organization Name: | SPIRIT PHYSICIAN SERVICES, INC |
NPI Number: | 1194183822 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID A GATESMAN (VICE -PRESIDENT) |
Mailing Address: | 20 Erford Rd Wormleysburg |
State: | PA US |
Postal Code: | 170431163 |
Phone Number: | 7177633008 |
Fax Number: | 7179726865 |
NPI Enumeration Date: | 02/09/2016 |
NPI Last Update Date: | 02/17/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |