Provider Demographics
NPI:1053451310
Name:BRADFORD COUNTY HUMAN SERVICES
Entity Type:Organization
Organization Name:BRADFORD COUNTY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-1760
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1822
Mailing Address - Country:US
Mailing Address - Phone:570-265-1760
Mailing Address - Fax:570-265-8541
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:UNIT 1
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1822
Practice Address - Country:US
Practice Address - Phone:570-265-1760
Practice Address - Fax:570-265-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1000072830014251B00000X
PA1007780690003251B00000X
PA1007780690001251B00000X
PA1007780690006251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management