Provider Demographics
NPI:1134308570
Name:CENTER FOR DEVELOPMENTAL DISABILITIES OF PIKE COUNTY
Entity Type:Organization
Organization Name:CENTER FOR DEVELOPMENTAL DISABILITIES OF PIKE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-296-3992
Mailing Address - Street 1:101 POCONO DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9408
Mailing Address - Country:US
Mailing Address - Phone:570-296-3992
Mailing Address - Fax:570-296-4919
Practice Address - Street 1:101 POCONO DRVIE
Practice Address - Street 2:SUITE 2
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9408
Practice Address - Country:US
Practice Address - Phone:570-296-3992
Practice Address - Fax:570-296-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PA243890252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty