MEDICARE: ELLEN OBRIEN GAISER ADDICTION CENTER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	107025	PA
2	251S00000X	Community/Behavioral Health Agency	107025	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740467976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN OBRIEN GAISER ADDICTION CENTER

Provider Business Mailing Address
First Line	:	315 LIBERTY ST
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-5803
Country	:	US
Telephone Number	:	724-256-8882
Fax Number	:	724-256-8879

Provider Business Practice Location Address
First Line	:	315 LIBERTY STREET
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-0000
Country	:	US
Telephone Number	:	724-256-8882
Fax Number	:	724-256-8879

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LINDA ANN FRANIEWSKI
Credential	:	MBA
Telephone Number	:	724-287-8205

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	04/29/2009

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