Provider Demographics
NPI:1235264912
Name:THE COMMUNITY INTERVENTION CENTER
Entity Type:Organization
Organization Name:THE COMMUNITY INTERVENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:QUINN
Authorized Official - Last Name:FINNERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-342-4298
Mailing Address - Street 1:445 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-2101
Mailing Address - Country:US
Mailing Address - Phone:570-342-4298
Mailing Address - Fax:570-343-2804
Practice Address - Street 1:445 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-2101
Practice Address - Country:US
Practice Address - Phone:570-342-4298
Practice Address - Fax:570-343-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016532920002OtherCCBH GRP