1689740839 NPI number — FAMILY CARE FOR CHILDREN & YOUTH, INC.

Table of content: (NPI 1689740839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689740839 NPI number — FAMILY CARE FOR CHILDREN & YOUTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CARE FOR CHILDREN & YOUTH, 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:
FAMILY BEHAVIORAL HEALTH PROGRAM
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:
1689740839
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:
25 BELFORD BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17847-9701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-522-9790
Provider Business Mailing Address Fax Number:
570-522-0016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 ROOSEVELT AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17401-3378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-846-3909
Provider Business Practice Location Address Fax Number:
717-846-9674
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STORER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
TERESA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
570-522-9790

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  311050 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QM0850X , with the licence number: 311050 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QM0855X , with the licence number: 311050 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320800000X , with the licence number: 212580 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1001317940019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1001317940004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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