Provider Demographics
NPI:1619260916
Name:RESURGENCE FAMILY PRESERVATION SERVICES, LLC
Entity type:Organization
Organization Name:RESURGENCE FAMILY PRESERVATION SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:III
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:717-695-4525
Mailing Address - Street 1:2330 VARTAN WAY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9763
Mailing Address - Country:US
Mailing Address - Phone:717-695-4525
Mailing Address - Fax:717-798-9283
Practice Address - Street 1:2330 VARTAN WAY
Practice Address - Street 2:SUITE 135
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9763
Practice Address - Country:US
Practice Address - Phone:717-695-4525
Practice Address - Fax:717-798-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0168951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty