| NPI | 1770955874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM SOHOSKY COO 570-628-5215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2019-08-28 |