NPIMap

Organization Active NPI

Spirtilife

  • Substance Abuse Rehabilitation Facility
  • Penn Run, PA
National Provider Identifier
1609250976
Registry record updated Jul 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
327027 Issued in PA
Legal business name
SPIRTILIFE
Practice address
170 FR Martin Telenson Rd
Penn Run, PA 15765-7336
Phone
(724) 465-2165
NPI assigned
Jul 16, 2015
Last updated
Jul 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Louis E Wagner
Title
Executive Director
Phone
(724) 465-2165

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 327027 PA Primary

Addresses

Primary practice location

170 FR Martin Telenson Rd
Penn Run, PA 15765-7336

Mailing address

170 FR Martin Telenson Rd
Penn Run, PA 15765-7336
Phone (724) 465-2165

National Provider Directory

National Provider Directory

Locations

170 Fr Martin Telenson Rd
Penn Run, PA 15765
Phone (724) 465-2165

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1609250976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 FR MARTIN TELENSON RD",
            "city": "PENN RUN",
            "state": "PA",
            "postal_code": "157657336",
            "telephone_number": "724-465-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 FR MARTIN TELENSON RD",
            "city": "PENN RUN",
            "state": "PA",
            "postal_code": "157657336",
            "telephone_number": "724-465-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPIRTILIFE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2015-07-16",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "724-465-2165"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "PA",
            "license": "327027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Penn Run, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.