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General NPI Number Information
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NPI Number | 1649303025
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Entity Type | Organization
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Legal Business Name | CAMBRIA RESIDENTIAL SERVICES, INC.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 167 WOODLAND BLVD
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City | PORTAGE
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State | PA
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Zip | 15946-1431
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Country | US
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Telephone | 814-736-9584
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Fax |
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Provider Business Mailing Address
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Address Line | 338 BLOOMFIELD ST SUITE 100
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3272
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Country | US
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Telephone | 814-266-1829
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Fax | 814-262-0423
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JAMES J. COOK
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Credential |
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Telephone | 814-266-1829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 739310
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License Number State | PA
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