Healthcare Provider Details

I. General information

NPI: 1952373250
Provider Name (Legal Business Name): FRIENDSHIP HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 MAPLE ST
SCRANTON PA
18505-2707
US

IV. Provider business mailing address

1509 MAPLE ST
SCRANTON PA
18505-2707
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-8305
  • Fax: 570-344-1172
Mailing address:
  • Phone: 570-342-8305
  • Fax: 570-344-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number109710
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number225110
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier100759410-0048
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier100759410-0018
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MS. CHRISTINE A. GILROY
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: CPA
Phone: 570-342-8305