1083712830 NPI number — NORTHEAST TREATMENT CENTERS, INC.

Table of content: (NPI 1083712830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083712830 NPI number — NORTHEAST TREATMENT CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST TREATMENT CENTERS, 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:
NORTHEAST TREATMENT CENTERS
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:
1083712830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
499 N 5TH ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-451-7000
Provider Business Mailing Address Fax Number:
215-451-7110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 N 5TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-451-7015
Provider Business Practice Location Address Fax Number:
215-451-7110
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STRAUSS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF FINANCIAL OFFICER
Authorized Official Telephone Number:
215-240-8298

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  104870 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 104870 , registered in the state of PA ; 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: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0004972000 . This is a "MAGELLAN PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 296503000 . This is a "MAGELLAN HEALTH CHOICES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 462315000 . This is a "MAGELLAN HEALTH CHOICES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 159997 . This is a "BLUE CROSS OF DELAWARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000022246 . This is a "DIAMOND STATE PARTNERS ME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000838 . This is a "COMMUNITY CARE BEHAVIORAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 273261 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 311749 . This is a "MAGELLAN KEYSTONE HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 273261 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 311749 . This is a "MAGELLAN KEYSTONE HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 100022246 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004972000 . This is a "MAGELLAN PERSONAL CHOICE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 046410000 . This is a "MAGELLAN COMMERCIAL" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 046410000 . This is a "MAGELLAN COMMERCIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100773886 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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