Organization
EHPP CHESTNUT RIDGE LLC
Active
Parent organization
MEDVANTX, INC.
Other names
Excela Chestnut Ridge Ligonier
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
117 W WELLINGTON ALY, LIGONIER, PA 15658-6201
(724) 238-6668
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD016675
PA
Other
Enumeration date
01/09/2009
Last updated
07/19/2016
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