Organization
PENNSYLVANIA CARE, LLC
Active
Other names
Miners Medical
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYN TANIS (EXECUTIVE DIRECTOR OF CONTRACT MGMT)
(856) 533-8762
Entity
Organization
Contact information
Practice address
43 S MAIN ST, ASHLEY, PA 18706-1506
(570) 822-5145
(570) 822-5147
Mailing address
1317 ROUTE 73 STE 200, MOUNT LAUREL, NJ 08054-2202
(856) 429-6111
(570) 822-5147
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
407058
PA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
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Other
Enumeration date
02/11/2011
Last updated
07/18/2022
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