1831193259 NPI number — ALCOHOLISM AND DRUG SERVICES OF LOWER LUZERNE COUNTY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831193259 NPI number — ALCOHOLISM AND DRUG SERVICES OF LOWER LUZERNE COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALCOHOLISM AND DRUG SERVICES OF LOWER LUZERNE COUNTY, 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:
6
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:
1831193259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 W BROAD ST
Provider Second Line Business Mailing Address:
FL 2
Provider Business Mailing Address City Name:
HAZLETON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18201-6500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-455-9902
Provider Business Mailing Address Fax Number:
570-455-9452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 W BROAD ST
Provider Second Line Business Practice Location Address:
FL 2
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18201-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-455-9902
Provider Business Practice Location Address Fax Number:
570-455-9452
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PANE
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
570-455-9902

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  402249 , 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)





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