Lumos Behavioral Health Fayetteville, LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

LUMOS BEHAVIORAL HEALTH FAYETTEVILLE, LLC

Practice address

11302 S Mountain Rd
Fayetteville, PA 17222-9626

Phone

(717) 500-1111

NPI assigned

Feb 23, 2026

Organization subpart

No

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

Authorized official

Name

Lawrence Weiss

Title

Ceo

Phone

(917) 816-5353

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1771804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771804800000",
    "number": "1619821022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 GROVE AVE UNIT 339",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115164014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11302 S MOUNTAIN RD",
            "city": "FAYETTEVILLE",
            "state": "PA",
            "postal_code": "172229626",
            "telephone_number": "717-500-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMOS BEHAVIORAL HEALTH FAYETTEVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-23",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "917-816-5353"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Anthony Jeffrey, B.SC .(PHARM);R.PH.
• Leo E Kratz, DO
• Lisa Lease
• Audrey Linn List, PT
• Kevin John List, PT
• Tejas Nirmalkumar Narechania, PHARMACIST
• Yin Keong Ngeow, M.D.
• Jason Christopher Oday
• Daniel Ogbefho
• Paul Douglas Orange, M.D.

• Psychiatric Residential Treatment Facility in Fayetteville, PA
• Providers in Fayetteville, PA by specialty
• Psychiatric Residential Treatment Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2026; 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.