Basic Information
| Provider Information | |||||||||
| NPI: | 1689297681 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARS OF EPHRATA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 ONIX DR | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193481886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025982043 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 S STATE ST | ||||||||
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| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175222410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177406910 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2020 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | GENEVIEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4847312500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
ID Information
| ID | Type | State | Issuer | Description | 367101 | 01 | PA | STATE LICENSE | OTHER |