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General NPI Number Information
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NPI Number | 1659591360
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Entity Type | Organization
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Legal Business Name | LUZERNE WYOMING COUNTY MENTAL HEALTH CENTER 1
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 562 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3721
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Country | US
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Telephone | 570-552-3900
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Fax | 570-552-3907
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Provider Business Mailing Address
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Address Line | 562 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3721
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Country | US
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Telephone | 570-552-3900
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Fax | 570-552-3907
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | JOSEPH KNECHT
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Credential |
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Telephone | 570-552-3975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 238650
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License Number State | PA
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