Healthcare Provider Details

I. General information

NPI: 1669663753
Provider Name (Legal Business Name): CARBON-MONROE-PIKE MH/MR PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 NORTH ST SUITE 3
LEHIGHTON PA
18235-1546
US

IV. Provider business mailing address

724 PHILLIPS ST SUITE 202
STROUDSBURG PA
18360-2242
US

V. Phone/Fax

Practice location:
  • Phone: 570-420-1900
  • Fax: 570-517-5422
Mailing address:
  • Phone: 570-420-1900
  • Fax: 570-517-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHEILA THEODOROU
Title or Position: ADMINISTRATOR
Credential:
Phone: 570-420-1900