1619947348 NPI number — CARBON - MONROE - PIKE DRUG & ALCOHOL COMMISSION, INC

Table of content: (NPI 1619947348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619947348 NPI number — CARBON - MONROE - PIKE DRUG & ALCOHOL COMMISSION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARBON - MONROE - PIKE DRUG & ALCOHOL COMMISSION, INC
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:
1619947348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 PHILLIPS STREET
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18360-2242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-421-1960
Provider Business Mailing Address Fax Number:
570-421-3548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 S. 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-5177
Provider Business Practice Location Address Fax Number:
610-377-5099
Provider Enumeration Date:
01/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DRAKE
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
570-421-1960

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  131044 , 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: 451044 , 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: 100773607 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".