Provider Demographics
NPI:1174959019
Name:GOOD WORKS LIFE RECOVERY HOUSE
Entity type:Organization
Organization Name:GOOD WORKS LIFE RECOVERY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:IFRAIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:724-880-6030
Mailing Address - Street 1:102 OLD WYNN RD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-6388
Mailing Address - Country:US
Mailing Address - Phone:724-880-6030
Mailing Address - Fax:724-564-0253
Practice Address - Street 1:102 OLD WYNN RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-6388
Practice Address - Country:US
Practice Address - Phone:724-880-6030
Practice Address - Fax:724-564-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA267017324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility