1386642296 NPI number — DISCOVERY HOUSE, LLC

Table of content: (NPI 1386642296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386642296 NPI number — DISCOVERY HOUSE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISCOVERY HOUSE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386642296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6183 PASEO DEL NORTE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92011-1151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-861-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2755 PHILMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19006-5368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-947-4100
Provider Business Practice Location Address Fax Number:
215-947-0192
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FARLEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
PHILLIP
Authorized Official Title or Position:
VP & SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  09707 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , with the licence number: 09070 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X , with the licence number: 097070 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0015931730001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330536 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 501897 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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