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General NPI Number Information
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NPI Number | 1316161706
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Entity Type | Organization
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Legal Business Name | LUZERNE TREATMENT CENTER
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 600 E LUZERNE ST LUZERNE TREATMENT CENTERS
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City | PHILADELPHIA
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State | PA
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Zip | 19124-4228
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Country | US
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Telephone | 215-634-8960
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Fax | 215-634-8964
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Provider Business Mailing Address
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Address Line | 35 FAIRFIELD PL COMMUNITY EDUCATION CENTERS
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City | WEST CALDWELL
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State | NJ
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Zip | 07006-6206
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Country | US
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Telephone | 973-226-2900
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Fax | 215-634-8962
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Authorized Official
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Title or Position | DIRECTOR OF RE-ENTRY OPERATIONS
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Name | BERTEE THOMAS
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Credential | PSY.D
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Telephone | 215-744-9601
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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 | 807372
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | PA
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