Organization
GEORGE JUNIOR REPUBLIC IN PENNSYLVANIA
Active
Other names
Memorial
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 ROAD, GROVE CITY, PA 16237
(724) 458-9330
Mailing address
PO BOX 1058, 233 GEORGE JUNIOR ROAD, GROVE CITY, PA 16127-5058
(724) 458-9330
(724) 458-0389
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014522190054
—
PA
05
—
0014522190118
—
PA
Enumeration date
03/20/2007
Last updated
01/12/2010
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