Provider Demographics
NPI:1700141413
Name:SANTE INTEGRATIVE MEDICINE, LLC
Entity type:Organization
Organization Name:SANTE INTEGRATIVE MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-737-9646
Mailing Address - Street 1:304 BLACKLATCH LN
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-8412
Mailing Address - Country:US
Mailing Address - Phone:717-737-9646
Mailing Address - Fax:
Practice Address - Street 1:49 PRINCE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3113
Practice Address - Country:US
Practice Address - Phone:717-545-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065431L261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty