Healthcare Provider Details

I. General information

NPI: 1780218594
Provider Name (Legal Business Name): DAVIS ARCHWAY CENTERS FOR ADDICTION TREATMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 COURSON LN
EMLENTON PA
16373-2502
US

IV. Provider business mailing address

114 COURSON LN
EMLENTON PA
16373-2502
US

V. Phone/Fax

Practice location:
  • Phone: 724-867-0202
  • Fax: 724-867-0270
Mailing address:
  • Phone: 724-867-0202
  • Fax: 724-867-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHET LEECH
Title or Position: CEO
Credential: MS
Phone: 724-867-0202