Organization
LIBERATION WAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDEN COLUCCIO (CFO)
(877) 636-9322
Entity
Organization
Contact information
Practice address
225 E CITY AVE, BALA CYNWYD, PA 19004-1704
(877) 636-9322
Mailing address
PO BOX 826742, PHILADELPHIA, PA 19182-1704
(877) 636-9322
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
097105
PA
Other
Enumeration date
07/13/2016
Last updated
07/13/2016
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