Organization
EHPP CHESTNUT RIDGE LLC
Active
Parent organization
MEDVANTX, INC.
Other names
Excela Chestnut Ridge New Alexandria
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
401 MAIN ST, NEW ALEXANDRIA, PA 15670
(724) 668-7147
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD023700
PA
Other
Enumeration date
01/13/2009
Last updated
10/23/2012
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