Organization
PENNREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULINE BAILO (DIRECTOR)
(215) 475-2401
Entity
Organization
Contact information
Practice address
1000 BROADWAY APT 115, WESTVILLE, NJ 08093-1438
(215) 409-5519
Mailing address
18 S MAIN ST, ALLENTOWN, NJ 08501-1610
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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