Healthcare Provider Details

I. General information

NPI: 1770925992
Provider Name (Legal Business Name): NORTHEAST TREATMENT CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 WASHINGTON AVE
PHILADELPHIA PA
19146-1913
US

IV. Provider business mailing address

499 N 5TH ST SUITE A
PHILADELPHIA PA
19123-4005
US

V. Phone/Fax

Practice location:
  • Phone: 215-546-8060
  • Fax: 215-925-6897
Mailing address:
  • Phone: 215-451-7000
  • Fax: 215-925-6897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number140040
License Number StatePA

VIII. Authorized Official

Name: MS. ANNEMARIE STINSON
Title or Position: BILLING MANAGER
Credential:
Phone: 215-451-7015