Healthcare Provider Details

I. General information

NPI: 1215191663
Provider Name (Legal Business Name): MARTHA LLOYD CRF FLA MILLERTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 BLY RD
MILLERTON PA
16936-9465
US

IV. Provider business mailing address

190 W MAIN ST
TROY PA
16947-1131
US

V. Phone/Fax

Practice location:
  • Phone: 570-297-2185
  • Fax: 570-297-1019
Mailing address:
  • Phone: 570-297-2185
  • Fax: 570-297-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MILLER
Title or Position: CRF DIRECTOR
Credential:
Phone: 570-297-2185