Provider Demographics
NPI:1043304199
Name:NORTHEAST COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:NORTHEAST COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHLEBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-221-9136
Mailing Address - Street 1:2030 W TILGHMAN ST
Mailing Address - Street 2:SUITE 105B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4354
Mailing Address - Country:US
Mailing Address - Phone:484-221-9136
Mailing Address - Fax:484-221-9130
Practice Address - Street 1:2927 N 5TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2800
Practice Address - Country:US
Practice Address - Phone:215-291-4357
Practice Address - Fax:484-221-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA105610261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007295290004OtherCOMMUNITY BEHAVIORAL HEAL
PA1007295290004Medicaid
PA047340Medicare ID - Type Unspecified