1013982008 NPI number — DRUG AND ALCOHOL TREATMENT SERV

Table of content: (NPI 1013982008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013982008 NPI number — DRUG AND ALCOHOL TREATMENT SERV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRUG AND ALCOHOL TREATMENT SERV
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:
Provider Other Organization Name Type Code:
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:
1013982008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 N WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 3A
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18503-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-961-1997
Provider Business Mailing Address Fax Number:
570-344-9632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 WYOMING AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18503-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-3877
Provider Business Practice Location Address Fax Number:
570-344-1090
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCLAUGHLIN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
570-344-3877

Provider Taxonomy Codes

  • Taxonomy code: 276400000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 999022 . This is a "BCBS ID #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 90006 . This is a "GEISINGER HEALTH ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 093511 . This is a "FPH ID #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007465840002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4544717 . This is a "AETNA ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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