Provider Demographics
NPI:1225327018
Name:NORTHEAST TREATMENT CENTERS.INC
Entity Type:Organization
Organization Name:NORTHEAST TREATMENT CENTERS.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-451-7000
Mailing Address - Street 1:499 N 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4005
Mailing Address - Country:US
Mailing Address - Phone:215-451-7000
Mailing Address - Fax:215-925-6897
Practice Address - Street 1:5501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3205
Practice Address - Country:US
Practice Address - Phone:215-451-7000
Practice Address - Fax:215-451-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PA807359261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100773886Medicaid
PA100773886OtherCOMMUNITY BEHAVIORAL HEALTH (CBH)
PA100773886OtherMAGELLAN HEALTH CHOICES