Organization
GEORGE JUNIOR REPUBLIC IN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD L. LOSASSO MSW (CHIEF EXECUTIVE OFFICER)
(724) 458-9330
Entity
Organization
Contact information
Practice address
233 GEORGE JUNIOR RD, GROVE CITY, PA 16127-4417
(724) 458-9330
(724) 458-0389
Mailing address
233 GEORGE JUNIOR RD, GROVE CITY, PA 16127-4417
(724) 458-9330
(724) 458-0389
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
442300
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
442300
COMMONWEALTH OF PENNSYLVANIA - OMHSAS
PA
Enumeration date
06/30/2010
Last updated
06/30/2010
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