Healthcare Provider Details

I. General information

NPI: 1033386370
Provider Name (Legal Business Name): CMSU MH/MR AND D&A PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E MARKET ST SUITE 200
DANVILLE PA
17821-2161
US

IV. Provider business mailing address

PO BOX 219
DANVILLE PA
17821-0219
US

V. Phone/Fax

Practice location:
  • Phone: 570-275-4962
  • Fax:
Mailing address:
  • Phone: 570-275-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number318410
License Number StatePA

VIII. Authorized Official

Name: MR. PHILIP T KEATING
Title or Position: ADMINISTRATOR
Credential: MS
Phone: 570-275-5422