Organization
GLADE RUN LUTHERAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES T. LOCKWOOD (EXECUTIVE DIRECTOR)
(724) 452-4453
Entity
Organization
Contact information
Practice address
70 BEAVER ROAD, ZELIENOPLE, PA 16063
(724) 452-4453
(724) 452-6576
Mailing address
PO BOX 70, ZELIENOPLE, PA 16063-0070
(724) 452-4453
(724) 452-6576
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007542540028
—
PA
Enumeration date
09/17/2007
Last updated
09/17/2007
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