Provider Demographics
NPI:1043085608
Name:GEMINI RECOVERY CENTERS AT SCRANTON, LLC
Entity Type:Organization
Organization Name:GEMINI RECOVERY CENTERS AT SCRANTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:718-530-3535
Mailing Address - Street 1:1123 CAPOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2730
Mailing Address - Country:US
Mailing Address - Phone:718-530-3535
Mailing Address - Fax:570-451-5250
Practice Address - Street 1:1123 CAPOUSE AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2730
Practice Address - Country:US
Practice Address - Phone:718-530-3535
Practice Address - Fax:570-451-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder