MEDICARE: NORTHEAST TREATMENT CENTERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	807327	PA
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	807327	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100773886	OTHER	PA	MAGELLAN HEALTH CHOICES
2	100773886	OTHER	PA	COMMUNITY BEHAVIORAL HEALTH (CBH)
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407145295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST TREATMENT CENTERS, INC

Provider Business Mailing Address
First Line	:	499 N 5TH ST
Second Line	:	SUITE A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-4005
Country	:	US
Telephone Number	:	215-451-7000
Fax Number	:	215-925-6897

Provider Business Practice Location Address
First Line	:	2701 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2743
Country	:	US
Telephone Number	:	215-451-7000
Fax Number	:	215-451-7010

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JONATHAN SOLOMONS
Credential	:
Telephone Number	:	215-451-7000

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	07/03/2013

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