Organization Active NPI

Liberty Pine Recovery LLC

Doing business as Lifeline Recovery and Wellness

  • Substance Abuse Rehabilitation Facility
  • Malvern, PA
National Provider Identifier
1932991049
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
LIBERTY PINE RECOVERY LLC
Doing business as
Lifeline Recovery and Wellness
Practice address
255 Great Valley Pkwy Ste 200
Malvern, PA 19355-1300
Phone
(856) 693-3007
NPI assigned
May 22, 2025
Last updated
May 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Authorized official

Name
Robert Whedon
Title
Member/Partner
Phone
(856) 693-3007

Specialties & licenses 1

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

Addresses

Primary practice location

255 Great Valley Pkwy Ste 200
Malvern, PA 19355-1300

Mailing address

255 Great Valley Pkwy Ste 200
Malvern, PA 19355-1300

Other names 1

  • Lifeline Recovery and Wellness Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2331217Liberty Pine Recovery LLC255 Great Valley Prkwy, Ste 200, Malvern, PA 19355Certificate of waiverSep 28, 2027

National Provider Directory

National Provider Directory

Locations

255 Great Valley Pkwy
Ste 200
Malvern, PA 19355
Phone (856) 693-3007

NPI Registry JSON

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

{
    "created_epoch": "1747872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1932991049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 GREAT VALLEY PKWY STE 200",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193551300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 GREAT VALLEY PKWY STE 200",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193551300",
            "telephone_number": "856-693-3007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY PINE RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-22",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A",
        "authorized_official_last_name": "WHEDON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MEMBER/PARTNER",
        "authorized_official_telephone_number": "856-693-3007"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifeline Recovery and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Malvern, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.