Organization
PENNREACH
Active
Other names
Cristal Wagner, Kristin Everett
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL ODELL MED (CEO)
(215) 409-5519
Entity
Organization
Contact information
Practice address
18 S MAIN ST, ALLENTOWN, NJ 08501-1610
(267) 559-1152
Mailing address
18 S MAIN ST, ALLENTOWN, NJ 08501-1610
(215) 409-5519
(609) 259-4121
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
251B00000X
Case Management Agency
Primary
—
—
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
—
—
Other
Enumeration date
05/02/2015
Last updated
10/17/2025
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