Healthcare Provider Details

I. General information

NPI: 1306003249
Provider Name (Legal Business Name): LACKAWANNA/SUSQUEHANNA OFFICE OF DRUG AND ALCOHOL PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 LINDEN ST 5TH FLOOR
SCRANTON PA
18503-1608
US

IV. Provider business mailing address

507 LINDEN STREET 5TH FLOOR
SCRANTON PA
18503-1633
US

V. Phone/Fax

Practice location:
  • Phone: 570-963-6743
  • Fax: 570-963-6617
Mailing address:
  • Phone: 570-963-6820
  • Fax: 570-963-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. WILLIAM P. HOBAN
Title or Position: DIRECTOR
Credential:
Phone: 570-963-6820