1366609646 NPI number — CHILDREN'S CENTER FOR TREATMENT AND EDUCATION

Table of content: (NPI 1366609646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366609646 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:
1366609646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2020
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:
814-817-1400
Provider Business Mailing Address Fax Number:
814-817-1447

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:
16365-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-817-1400
Provider Business Practice Location Address Fax Number:
814-817-1447
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TECONCHUK
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CONTRACT MANAGER
Authorized Official Telephone Number:
814-817-1400

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007710210084 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210088 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210114 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210057 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210071 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210079 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210081 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210083 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210087 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210075 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210092 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210108 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007710210076 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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