LIFEBACK OF PENNSYLVANIA LLC

Clinic/Center — Mental Health (Including Community Mental Health Center)

Code: 261QM0801X

Clinic/Center — Adult Mental Health

Code: 261QM0850X

Clinic/Center — Adolescent and Children Mental Health

Code: 261QM0855X

Clinic/Center — Rehabilitation, Substance Use Disorder

Code: 261QR0405X