1467097675 NPI number — CHILDREN'S CENTER FOR TREATMENT AND EDUCATION

Table of content: (NPI 1467097675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467097675 NPI number — CHILDREN'S CENTER FOR TREATMENT AND EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
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:
BEACON LIGHT BEHAVIORAL HEALTH SYSTEM
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:
1467097675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16701-3278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-817-1400
Provider Business Mailing Address Fax Number:
814-362-5245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 FREEPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KITTANNING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16201-4564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-817-1400
Provider Business Practice Location Address Fax Number:
814-362-5245
Provider Enumeration Date:
11/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CARY
Authorized Official First Name:
TINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CRED
Authorized Official Telephone Number:
814-817-1400

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 450800 . This is a "CERTIFICATION OF COMPLIANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 227250 . This is a "CERTIFICATION OF COMPLIANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100771021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 447520 . This is a "CERTIFICATE OF COMPLIANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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