Healthcare Provider Details

I. General information

NPI: 1043085608
Provider Name (Legal Business Name): GEMINI RECOVERY CENTERS AT SCRANTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 CAPOUSE AVE
SCRANTON PA
18509-2730
US

IV. Provider business mailing address

1123 CAPOUSE AVE
SCRANTON PA
18509-2730
US

V. Phone/Fax

Practice location:
  • Phone: 718-530-3535
  • Fax: 570-451-5250
Mailing address:
  • Phone: 718-530-3535
  • Fax: 570-451-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
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: ALEXIS A. BAEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 718-530-3535