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General NPI Number Information
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NPI Number | 1962680751
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Entity Type | Organization
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Legal Business Name | NORTHEAST TREATMENT CENTERS. INC.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 499 N 5TH ST SUITE D-E
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4005
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Country | US
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Telephone | 215-451-7100
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Fax | 215-925-6897
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Provider Business Mailing Address
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Address Line | 499 N 5TH ST SUITE A
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4005
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Country | US
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Telephone | 215-451-7000
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Fax | 215-925-6897
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. KEVIN NOEL
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Credential |
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Telephone | 215-451-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 910194
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 910194
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 910194
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License Number State | PA
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