Healthcare Provider Details

I. General information

NPI: 1306242821
Provider Name (Legal Business Name): NEW DIRECTIONS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W 11TH ST 2ND FLOOR
ERIE PA
16501-1746
US

IV. Provider business mailing address

306 W 11TH ST 2ND FLOOR
ERIE PA
16501-1746
US

V. Phone/Fax

Practice location:
  • Phone: 814-240-6216
  • Fax: 814-240-6219
Mailing address:
  • Phone: 814-240-6216
  • Fax: 814-240-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number257084
License Number StatePA

VIII. Authorized Official

Name: KARA ANN BENNETT
Title or Position: FACILITY DIRECTOR
Credential: C.R.N.P.
Phone: 814-240-6216