MEDICARE: CAMBRIA RESIDENTIAL SERVICES, 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
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	739310	PA

General Provider Information

NPI Number	:	1649303025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMBRIA RESIDENTIAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	338 BLOOMFIELD ST
Second Line	:	SUITE 100
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-3272
Country	:	US
Telephone Number	:	814-266-1829
Fax Number	:	814-262-0423

Provider Business Practice Location Address
First Line	:	167 WOODLAND BLVD
Second Line	:
City	:	PORTAGE
State	:	PA
Zip	:	15946-1431
Country	:	US
Telephone Number	:	814-736-9584
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES J. COOK
Credential	:
Telephone Number	:	814-266-1829

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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