Organization
CLEM-MAR HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONYA MOWRY BS, MS, CCMS, CCDP (ASSISTANT PROJECT DIRECTOR)
(570) 288-0403
Entity
Organization
Contact information
Practice address
542 MAIN ST, EDWARDSVILLE, PA 18704-2504
(570) 288-0403
Mailing address
PO BOX 2028, KINGSTON, PA 18704-7038
(570) 288-0403
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
407054
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016199680002
—
PA
05
—
0016199680004
—
PA
05
—
0016199680005
—
PA
Enumeration date
04/12/2007
Last updated
08/22/2020
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