| Commonwealth Clinical Group, Inc. | |
|
479 Thomas Jones Way Ste 100 Exton PA 19341-2585 | |
| (484) 879-6751 | |
| (484) 879-6759 |
| Full Name | Commonwealth Clinical Group, Inc. |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 479 Thomas Jones Way Ste 100, Exton, Pennsylvania |
| Authorized Official Name and Position | Stacie Basham (BILLING COORDINATOR) |
| Authorized Official Contact | 7173933900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Commonwealth Clinical Group, Inc. 41 E Orange St Lancaster PA 17602-2846 Ph: (717) 393-3900 | Commonwealth Clinical Group, Inc. 479 Thomas Jones Way Ste 100 Exton PA 19341-2585 Ph: (484) 879-6751 |
| NPI Number | 1013530898 |
|---|---|
| Provider Enumeration Date | 05/27/2020 |
| Last Update Date | 09/15/2021 |
| Certification Date | 09/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013530898 | NPI | - | NPPES |
| 146330 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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