Organization
SPIRTILIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS E WAGNER (EXECUTIVE DIRECTOR)
(724) 465-2165
Entity
Organization
Contact information
Practice address
170 FR MARTIN TELENSON RD, PENN RUN, PA 15765-7336
(724) 465-2165
Mailing address
170 FR MARTIN TELENSON RD, PENN RUN, PA 15765-7336
(724) 465-2165
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
327027
PA
Other
Enumeration date
07/16/2015
Last updated
07/16/2015
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