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General NPI Number Information
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NPI Number | 1184741274
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 585 E. MAIN STREET
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City | YOUNGSVILLE
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State | PA
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Zip | 16371-1129
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Country | US
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Telephone | 814-817-1400
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Fax | 814-817-1447
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Provider Business Mailing Address
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Address Line | 800 EAST MAIN STREET
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City | BRADFORD
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State | PA
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Zip | 16701-3278
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Country | US
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Telephone | 814-817-1400
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Fax | 814-817-1447
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Authorized Official
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Title or Position | CONTROLLER
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Name | MRS. BRIDGET V MANGOLD
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Credential |
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Telephone | 814-817-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 423560
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License Number State | PA
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