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General NPI Number Information
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NPI Number | 1811051345
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Entity Type | Organization
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Legal Business Name | THE ELLEN O'BRIEN GAISER ADDICTION CENTER INC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 165 OLD PLANK RD
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City | BUTLER
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State | PA
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Zip | 16002-7523
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Country | US
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Telephone | 724-287-8205
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2127
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City | BUTLER
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State | PA
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Zip | 16003-2127
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Country | US
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Telephone | 724-287-8205
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LINDA FRANIEWSKI
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Credential |
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Telephone | 724-287-8205
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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 | 101064
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License Number State | PA
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