| NPI | 1063874568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY K LEIB CEO 570-537-6035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: PA 597030) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2019-01-28 |