=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841472669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPITAL AREA INTERMEDIATE UNIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2007
-----------------------------------------------------
Last Update Date | 12/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5668 STATE ROUTE 209
-----------------------------------------------------
City | LYKENS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17048-8414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-362-6624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 MILLER STREET
-----------------------------------------------------
City | SUMMERDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17093-0489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-732-8400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | AMY MORTON
-----------------------------------------------------
Credential | MS ED ADMINISTRATION
-----------------------------------------------------
Telephone | 717-732-8400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------