Organization
COMMONWEALTH CLINICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACIE BASHAM (BILLING COORDINATOR)
(717) 393-3900
Entity
Organization
Contact information
Practice address
450 S 5TH ST, READING, PA 19602-2642
(610) 372-5645
(610) 898-9229
Mailing address
41 E ORANGE ST, LANCASTER, PA 17602-2846
(717) 393-3900
(717) 393-7900
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228900
—
PA
Enumeration date
06/15/2020
Last updated
09/15/2021
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