Healthcare Provider Details

I. General information

NPI: 1104806793
Provider Name (Legal Business Name): CRAWFORD COUNTY DRUG & ALCOHOL EXECUTIVE COMMISSION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 WATER ST DOWNTOWN MALL
MEADVILLE PA
16335-3439
US

IV. Provider business mailing address

920 WATER ST DOWNTOWN MALL
MEADVILLE PA
16335-3439
US

V. Phone/Fax

Practice location:
  • Phone: 814-724-4100
  • Fax: 814-333-2779
Mailing address:
  • Phone: 814-724-4100
  • Fax: 814-333-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number201084
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number201084
License Number StatePA

VIII. Authorized Official

Name: DEBORAH J. DUFFY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-724-4100