1316161706 NPI number — LUZERNE TREATMENT CENTER

Table of content: (NPI 1316161706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316161706 NPI number — LUZERNE TREATMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUZERNE TREATMENT CENTER
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:
LUZERNE TREATMENT CENTER
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:
1316161706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 FAIRFIELD PL
Provider Second Line Business Mailing Address:
COMMUNITY EDUCATION CENTERS
Provider Business Mailing Address City Name:
WEST CALDWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07006-6206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-226-2900
Provider Business Mailing Address Fax Number:
215-634-8962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E LUZERNE ST
Provider Second Line Business Practice Location Address:
LUZERNE TREATMENT CENTERS
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-634-8960
Provider Business Practice Location Address Fax Number:
215-634-8964
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
BERTEE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF RE-ENTRY OPERATIONS
Authorized Official Telephone Number:
215-744-9601

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X , with the licence number: 807372 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: D0048 . This is a "BHSI OF PHILADELPHIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 774372000 . This is a "MAGELLAN BH OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 88868 . This is a "CBH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01824913 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com