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General NPI Number Information
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NPI Number | 1750418554
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Entity Type | Organization
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Legal Business Name | DICKINSON CENTER, INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 43 SERVIDEA
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City | RIDGWAY
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State | PA
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Zip | 15853
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Country | US
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Telephone | 814-772-2005
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Fax | 814-776-0234
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Provider Business Mailing Address
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Address Line | 43 SERVIDEA DRIVE
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City | RIDGWAY
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State | PA
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Zip | 15853
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Country | US
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Telephone | 814-776-2145
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Fax | 814-776-1470
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Authorized Official
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Title or Position | CEO
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Name | JACK A GROGA
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Credential |
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Telephone | 814-776-2145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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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 |
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