=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851344527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVERSIFIED TREATMENT ALTERNATIVES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 148 FAIRFIELD ROAD
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-524-9986
-----------------------------------------------------
Fax | 570-524-9973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 148 FAIRFIELD ROAD
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-524-9986
-----------------------------------------------------
Fax | 570-524-9973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. TIMOTHY J KELLEHER
-----------------------------------------------------
Credential | MA MED
-----------------------------------------------------
Telephone | 570-524-9986
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 348770
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 301960
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | 308000
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------