=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306242821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW DIRECTIONS HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2014
-----------------------------------------------------
Last Update Date | 04/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 W 11TH ST 2ND FLOOR
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16501-1746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-240-6216
-----------------------------------------------------
Fax | 814-240-6219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 W 11TH ST 2ND FLOOR
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16501-1746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-240-6216
-----------------------------------------------------
Fax | 814-240-6219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FACILITY DIRECTOR
-----------------------------------------------------
Name | KARA ANN BENNETT
-----------------------------------------------------
Credential | C.R.N.P.
-----------------------------------------------------
Telephone | 814-240-6216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2800X
-----------------------------------------------------
Taxonomy Name | Methadone Clinic
-----------------------------------------------------
License Number | 257084
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------