Provider Demographics
NPI:1093875080
Name:ARMSTRONG COUNTY COUNCIL ON ALCOHOL AND OTHER DRUGS, INC
Entity Type:Organization
Organization Name:ARMSTRONG COUNTY COUNCIL ON ALCOHOL AND OTHER DRUGS, INC
Other - Org Name:ARC MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:724-548-7607
Mailing Address - Street 1:200 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2708
Mailing Address - Country:US
Mailing Address - Phone:724-548-7607
Mailing Address - Fax:724-555-7999
Practice Address - Street 1:200 OAK AVE
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2708
Practice Address - Country:US
Practice Address - Phone:724-548-7607
Practice Address - Fax:724-555-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031056101YA0400X, 251S00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007718720008Medicaid
PA031056Medicaid
PA1007718720003Medicaid
PA1007718720007Medicaid