Provider Demographics
NPI:1083744338
Name:MONTGOMERY COUNTY EMERGENCY SERVICE CRISIS RESIDENTIAL PROGRAM
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY EMERGENCY SERVICE CRISIS RESIDENTIAL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-279-6100
Mailing Address - Street 1:50 BEECH DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5421
Mailing Address - Country:US
Mailing Address - Phone:610-279-6100
Mailing Address - Fax:610-279-0978
Practice Address - Street 1:100 EAGLEVILLE ROAD
Practice Address - Street 2:ACADIA HOUSE
Practice Address - City:EAGLESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1829
Practice Address - Country:US
Practice Address - Phone:610-631-2480
Practice Address - Fax:610-631-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103720320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007568020016Medicaid