1043331994 NPI number — CHILDREN'S CENTER FOR TREATMENT AND EDUCATION

Table of content: (NPI 1043331994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043331994 NPI number — CHILDREN'S CENTER FOR TREATMENT AND EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEACON LIGHT BEHAVIORAL HEALTH SYSTEMS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043331994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16701-3278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-362-5250
Provider Business Mailing Address Fax Number:
814-362-2185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1885 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-723-1832
Provider Business Practice Location Address Fax Number:
814-362-5245
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARY
Authorized Official First Name:
TINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
814-817-1400

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100771021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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