Healthcare Provider Details

I. General information

NPI: 1174379465
Provider Name (Legal Business Name): ANTHRACITE REGION CENTER FOR INDEPENDENT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 W BROAD ST STE 228
HAZLETON PA
18201-6401
US

IV. Provider business mailing address

8 W BROAD ST STE 228
HAZLETON PA
18201-6401
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-9800
  • Fax: 570-455-1731
Mailing address:
  • Phone: 570-455-9800
  • Fax: 570-455-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA BRADLEY
Title or Position: FISCAL DIRECTOR
Credential:
Phone: 570-455-9800