Provider Demographics
NPI:1043331994
Name:CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
Entity Type:Organization
Organization Name:CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
Other - Org Name:BEACON LIGHT BEHAVIORAL HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-817-1400
Mailing Address - Street 1:800 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3278
Mailing Address - Country:US
Mailing Address - Phone:814-362-5250
Mailing Address - Fax:814-362-2185
Practice Address - Street 1:1885 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1277
Practice Address - Country:US
Practice Address - Phone:814-723-1832
Practice Address - Fax:814-362-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PA412160261Q00000X, 261QM0801X, 261QM0850X, 261QM0855X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100771021Medicaid