Provider Demographics
NPI:1083736722
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 SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:V
Authorized Official - Last Name:MANGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-817-1400
Mailing Address - Street 1:800 EAST MAIN STREET
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:814-817-1400
Mailing Address - Fax:814-817-1447
Practice Address - Street 1:100 ROBERT GABRIEL DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:ULSTER
Practice Address - State:PA
Practice Address - Zip Code:18850-0000
Practice Address - Country:US
Practice Address - Phone:814-817-1400
Practice Address - Fax:814-817-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA227240323P00000X, 323P00000X
PA207400323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007710210094Medicaid
PA1007710210095Medicaid