Organization
PENNREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULINE BAILO (PROGRAM DIRECTOR)
(215) 475-2401
Entity
Organization
Contact information
Practice address
18 S MAIN ST, ALLENTOWN, NJ 08501-1610
(215) 475-2401
Mailing address
18 S MAIN ST, ALLENTOWN, NJ 08501-1610
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710364385
—
NJ
Enumeration date
08/24/2017
Last updated
03/17/2018
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