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General NPI Number Information
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NPI Number | 1922582626
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Entity Type | Organization
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Legal Business Name | SHADRACH COUNSELING CENTER, INC
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 2001 BEDFORD ST
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City | JOHNSTOWN
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State | PA
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Zip | 15904-1096
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Country | US
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Telephone | 814-241-0047
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Fax |
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Provider Business Mailing Address
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Address Line | 15176 TYRONE PIKE
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City | CURWENSVILLE
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State | PA
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Zip | 16833-8319
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Country | US
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Telephone | 814-236-7406
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KRIS A CANFIELD
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Credential |
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Telephone | 814-236-7406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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