| NPI | 1376763649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY SIMMONS VP Finance 570-825-6425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: PA 1007280110021) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: PA 1007280110021) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2020-08-22 |