Healthcare Provider Details

I. General information

NPI: 1912966805
Provider Name (Legal Business Name): TRI COUNTY HUMAN SERVICES CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 FALLBROOK ST
CARBONDALE PA
18407-0514
US

IV. Provider business mailing address

185 FALLBROOK ST
CARBONDALE PA
18407-0514
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-1732
  • Fax: 570-282-6808
Mailing address:
  • Phone: 570-282-1732
  • Fax: 570-282-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. SPENCER A MOORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 570-282-1732