Healthcare Provider Details

I. General information

NPI: 1548381155
Provider Name (Legal Business Name): RAMSBOTTOM CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST MAIN STREET
BRADFORD PA
16701-3278
US

IV. Provider business mailing address

800 EAST MAIN STREET
BRADFORD PA
16701-3278
US

V. Phone/Fax

Practice location:
  • Phone: 814-817-1400
  • Fax: 814-817-1447
Mailing address:
  • Phone: 814-817-1400
  • Fax: 814-817-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number335610
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number844020
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number425250
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number425250
License Number StatePA

VIII. Authorized Official

Name: TINA CARY
Title or Position: CONTRACT MANAGER
Credential:
Phone: 814-817-1400