Organization
LIFEBACK OF PENNSYLVANIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARINETTA SEROTTE (PRESIDENT)
(609) 482-3701
Entity
Organization
Contact information
Practice address
10 S CLINTON ST STE 100, DOYLESTOWN, PA 18901-4220
(609) 482-3701
(215) 975-7300
Mailing address
10 S CLINTON ST STE 100, DOYLESTOWN, PA 18901-4220
(609) 482-3701
(215) 975-7300
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
09/08/2017
Last updated
12/28/2023
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