Provider Demographics
NPI:1043785405
Name:ENDLESS MOUNTAINS EXTENDED CARE, LLC
Entity Type:Organization
Organization Name:ENDLESS MOUNTAINS EXTENDED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:570-219-4401
Mailing Address - Street 1:1042 LITHIA VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-7949
Mailing Address - Country:US
Mailing Address - Phone:570-219-4401
Mailing Address - Fax:
Practice Address - Street 1:1042 LITHIA VALLEY RD
Practice Address - Street 2:
Practice Address - City:FACTORYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18419-7949
Practice Address - Country:US
Practice Address - Phone:570-219-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility