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Organization
GEORGE JUNIOR REPUBLIC IN PA
Active
Organization
GEORGE JUNIOR REPUBLIC IN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD L. LOSASSO MSW (CHIEF EXECUTIVE OFFICER)
(724) 458-9330
Entity
Organization
Contact information
Practice address
233 GEORGE JUNIOR RD, GROVE CITY, PA 16127-4417
(724) 458-9330
(724) 458-0389
Mailing address
233 GEORGE JUNIOR RD, GROVE CITY, PA 16127-4417
(724) 458-9330
(724) 458-0389
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
442300
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
442300
COMMONWEALTH OF PENNSYLVANIA - OMHSAS
PA
Enumeration date
06/30/2010
Last updated
06/30/2010
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