# LAKE SCRANTON RENEW CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LAKE SCRANTON URGENT CARE LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1770285769
- **Legal business name:** LAKE SCRANTON URGENT CARE LLC
- **Authorized official:** BRIANNE BALCHUNE (OFFICE MANAGER)
- **Authorized official phone:** (570) 800-5926

## Contact information

- **Practice address:** 1141 MOOSIC ST STE 3, SCRANTON, PA 18505-2105
- **Practice address phone:** (570) 800-5926
- **Practice address fax:** (570) 955-5556
- **Mailing address:** 1141 MOOSIC ST STE 3, SCRANTON, PA 18505-2105
- **Mailing address phone:** (570) 800-5926
- **Mailing address fax:** (570) 955-5556

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/21/2023
- **Last updated:** 04/19/2023