1902926835 NPI number — COUNCIL ON ALCOHOL AND DRUG ABUSE

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 1902926835 NPI number — COUNCIL ON ALCOHOL AND DRUG ABUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNCIL ON ALCOHOL AND DRUG ABUSE
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:
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:
1902926835
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:
1031 W LINDEN ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18102-3988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-437-0801
Provider Business Mailing Address Fax Number:
610-437-1997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 E 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-814-3108
Provider Business Practice Location Address Fax Number:
610-814-3109
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MINNICH
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
610-437-0801

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  487029 , 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)

  • Identifier: 1007531210001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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