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General NPI Number Information
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NPI Number | 1265933931
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Entity Type | Organization
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Legal Business Name | TEEN CHALLENGE TRAINING CENTER, INC.
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 329 E WISTER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19144-1828
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Country | US
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Telephone | 215-843-2887
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Fax |
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Provider Business Mailing Address
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Address Line | 33 TEEN CHALLENGE RD
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City | REHRERSBURG
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State | PA
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Zip | 19550-5000
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Country | US
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Telephone | 717-933-2804
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, FINANCE
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Name | BRUCE WHITE
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Credential |
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Telephone | 717-933-2804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 807166
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License Number State | PA
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