Provider Demographics
NPI:1275712705
Name:GREATER WILKES-BARRE ASSOCIATION FOR THE BLIND
Entity Type:Organization
Organization Name:GREATER WILKES-BARRE ASSOCIATION FOR THE BLIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:PETRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-693-3555
Mailing Address - Street 1:1825 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1444
Mailing Address - Country:US
Mailing Address - Phone:570-693-3555
Mailing Address - Fax:570-693-1307
Practice Address - Street 1:1825 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:PA
Practice Address - Zip Code:18643-1444
Practice Address - Country:US
Practice Address - Phone:570-693-3555
Practice Address - Fax:570-693-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare