Healthcare Provider Details

I. General information

NPI: 1457874166
Provider Name (Legal Business Name): ALTERNATIVE COMMUNITY RESOURCE PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 E CAMPBELL ST
CARROLLTOWN PA
15722-7302
US

IV. Provider business mailing address

131 MARKET ST
JOHNSTOWN PA
15901-1628
US

V. Phone/Fax

Practice location:
  • Phone: 814-535-2277
  • Fax:
Mailing address:
  • Phone: 814-535-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number315680
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FRANK J JANAKOVIC
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-535-2277