Healthcare Provider Details

I. General information

NPI: 1164154811
Provider Name (Legal Business Name): WE HAVE A CHOICE RECOVERY HOUSE FOR MEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 PROSPECT ST
TOBYHANNA PA
18466-7779
US

IV. Provider business mailing address

2114 TITANIA RD
TOBYHANNA PA
18466-8266
US

V. Phone/Fax

Practice location:
  • Phone: 570-534-5439
  • Fax:
Mailing address:
  • Phone: 570-534-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
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: KENNETH ANDRE RAMIREZ
Title or Position: EXECUTIVE DIRECTOR
Credential: RECOVERY SPECIALIST
Phone: 570-534-5439