Provider Demographics
NPI:1194184770
Name:MARTHA LLOYD COMMUNITY RESIDENTIAL FACILITY
Entity Type:Organization
Organization Name:MARTHA LLOYD COMMUNITY RESIDENTIAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-297-2185
Mailing Address - Street 1:66 LLOYD LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1502
Mailing Address - Country:US
Mailing Address - Phone:570-297-2185
Mailing Address - Fax:570-297-6161
Practice Address - Street 1:312 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1930
Practice Address - Country:US
Practice Address - Phone:570-297-2185
Practice Address - Fax:570-297-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA81792320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities