Provider Demographics
NPI:1174379465
Name:ANTHRACITE REGION CENTER FOR INDEPENDENT LIVING
Entity type:Organization
Organization Name:ANTHRACITE REGION CENTER FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-455-9800
Mailing Address - Street 1:8 W BROAD ST STE 228
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6401
Mailing Address - Country:US
Mailing Address - Phone:570-455-9800
Mailing Address - Fax:570-455-1731
Practice Address - Street 1:8 W BROAD ST STE 228
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6401
Practice Address - Country:US
Practice Address - Phone:570-455-9800
Practice Address - Fax:570-455-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)