Provider Demographics
NPI:1629953732
Name:PSYCHEDELIC HEALTHCARE INC
Entity type:Organization
Organization Name:PSYCHEDELIC HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SCHANER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:610-396-5139
Mailing Address - Street 1:2208 QUARRY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1158
Mailing Address - Country:US
Mailing Address - Phone:610-396-5139
Mailing Address - Fax:484-509-5141
Practice Address - Street 1:2208 QUARRY DR STE 200
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1158
Practice Address - Country:US
Practice Address - Phone:610-396-5139
Practice Address - Fax:484-509-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center