1780218594 NPI number — DAVIS ARCHWAY CENTERS FOR ADDICTION TREATMENT, INC.

Table of content: (NPI 1780218594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780218594 NPI number — DAVIS ARCHWAY CENTERS FOR ADDICTION TREATMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVIS ARCHWAY CENTERS FOR ADDICTION TREATMENT, 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:
1780218594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 COURSON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMLENTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16373-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-867-0202
Provider Business Mailing Address Fax Number:
724-867-0202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 COURSON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMLENTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16373-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-867-0202
Provider Business Practice Location Address Fax Number:
724-867-0270
Provider Enumeration Date:
03/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LEECH
Authorized Official First Name:
CHET
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
724-867-0202

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1024600580002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107112 . This is a "PENNSYLVANIA DEPARTMENT OF DRUG AND ALCOHOL PROGRAMS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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