Healthcare Provider Details

I. General information

NPI: 1215382684
Provider Name (Legal Business Name): CMSU BH/DS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TERRACE LN
DANVILLE PA
17821-2142
US

IV. Provider business mailing address

PO BOX 219
DANVILLE PA
17821-0219
US

V. Phone/Fax

Practice location:
  • Phone: 570-275-5422
  • Fax: 570-275-6610
Mailing address:
  • Phone: 570-275-5422
  • Fax: 570-275-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD D. BEACH
Title or Position: ADMINISTRATOR
Credential: LCSW, BCD
Phone: 570-275-5422