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901 Westminster Dr Williamsport PA 17701-3909 | |
| (570) 321-6127 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 901 Westminster Dr, Williamsport, Pennsylvania |
| Authorized Official Name and Position | Tom Callahan (REGIONAL VICE PRESIDENT) |
| Authorized Official Contact | 8008732131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
901 Westminster Dr Williamsport PA 17701-3909 Ph: (570) 321-6127 | 901 Westminster Dr Williamsport PA 17701-3909 Ph: (570) 321-6127 |
| NPI Number | 1902926918 |
|---|---|
| Provider Enumeration Date | 03/31/2007 |
| Last Update Date | 07/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902926918 | NPI | - | NPPES |
| 1007567870050 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 417030 (Pennsylvania) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 417030 (Pennsylvania) | Primary |
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