Provider Demographics
NPI:1235970443
Name:RESURRECTION HOUSE LLC
Entity type:Organization
Organization Name:RESURRECTION HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-679-2459
Mailing Address - Street 1:204 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:PA
Mailing Address - Zip Code:18821-9563
Mailing Address - Country:US
Mailing Address - Phone:570-679-2459
Mailing Address - Fax:570-413-0423
Practice Address - Street 1:204 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:PA
Practice Address - Zip Code:18821-9563
Practice Address - Country:US
Practice Address - Phone:570-679-2459
Practice Address - Fax:570-413-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder