Organization
GEORGE JUNIOR REPUBLIC IN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD L. LOSASSO (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
323P00000X
Psychiatric Residential Treatment Facility
Primary
447420
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
447420
PA STATE LICENCE
PA
Enumeration date
03/10/2016
Last updated
03/10/2016
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