| NPI | 1487276879 |
|---|---|
| Other Name | PROVIDENCE ROAD |
| Entity Type | Organization |
| Authorized Contact | JUDY KORGESKI Director 570-348-2911 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2020-05-08 |