Healthcare Provider Details

I. General information

NPI: 1972729416
Provider Name (Legal Business Name): CARBON LEHIGH INTERMEDIATE UNIT #21
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 LAFAYETTE AVE
PALMERTON PA
18071-1512
US

IV. Provider business mailing address

4210 INDEPENDENCE DRIVE
SCHNECKSVILLE PA
18078-2580
US

V. Phone/Fax

Practice location:
  • Phone: 610-826-4349
  • Fax: 610-826-3451
Mailing address:
  • Phone: 610-769-4111
  • Fax: 610-769-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number216190
License Number StatePA

VIII. Authorized Official

Name: MR. ROBERT J. KEEGAN JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 610-769-4111