Healthcare Provider Details

I. General information

NPI: 1548329022
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY OF NORTHEASTERN PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 WYOMING AVE
SCRANTON PA
18503-1227
US

IV. Provider business mailing address

425 WYOMING AVE
SCRANTON PA
18503-1227
US

V. Phone/Fax

Practice location:
  • Phone: 570-347-3357
  • Fax: 570-341-5308
Mailing address:
  • Phone: 570-347-3357
  • Fax: 570-341-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1000000210023
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: SARAH A. DROB
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 570-347-3357