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NPI Code Detail

MEDICARE: NORTHEAST COMMUNITY MENTAL HEALTH CENTER, INC.

MEDICARE: NORTHEAST COMMUNITY MENTAL HEALTH CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)105610PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11007295290004OTHERPACOMMUNITY BEHAVIORAL HEAL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043304199
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST COMMUNITY MENTAL HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : 2030 W TILGHMAN ST
Second Line : SUITE 105B
City : ALLENTOWN
State : PA
Zip : 18104-4354
Country : US
Telephone Number : 484-221-9136
Fax Number : 484-221-9130
Provider Business Practice Location Address
First Line : 2927 N 5TH ST
Second Line : 2ND FLOOR
City : PHILADELPHIA
State : PA
Zip : 19133-2800
Country : US
Telephone Number : 215-291-4357
Fax Number : 484-221-9136
Authorized Official
Title or Position : CEO
Name : MELISSA CHLEBOWSKI
Credential :
Telephone Number : 484-221-9136
Provider Enumeration Date : 10/03/2006
Last Update Date : 11/09/2007

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Directions to “NORTHEAST COMMUNITY MENTAL HEALTH CENTER, INC. ” Practice Location

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