Provider Demographics
NPI:1083712830
Name:NORTHEAST TREATMENT CENTERS, INC.
Entity Type:Organization
Organization Name:NORTHEAST TREATMENT CENTERS, INC.
Other - Org Name:NORTHEAST TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-240-8298
Mailing Address - Street 1:499 N 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123
Mailing Address - Country:US
Mailing Address - Phone:215-451-7000
Mailing Address - Fax:215-451-7110
Practice Address - Street 1:499 N 5TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123
Practice Address - Country:US
Practice Address - Phone:215-451-7015
Practice Address - Fax:215-451-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104870251B00000X, 251S00000X
261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0004972000OtherMAGELLAN PERSONAL CHOICE
PA296503000OtherMAGELLAN HEALTH CHOICES
PA462315000OtherMAGELLAN HEALTH CHOICES
159997OtherBLUE CROSS OF DELAWARE
1000022246OtherDIAMOND STATE PARTNERS ME
PA1000838OtherCOMMUNITY CARE BEHAVIORAL
PA273261OtherMANAGED HEALTH NETWORK
PA311749OtherMAGELLAN KEYSTONE HEALTH
DE273261OtherMANAGED HEALTH NETWORK
DE311749OtherMAGELLAN KEYSTONE HEALTH
DE100022246Medicaid
DE0004972000OtherMAGELLAN PERSONAL CHOICE
DE046410000OtherMAGELLAN COMMERCIAL
PA046410000OtherMAGELLAN COMMERCIAL
PA100773886Medicaid