Provider Demographics
NPI:1275912644
Name:ALTERNATIVE COMMUNITY RESOURCE PROGRAM
Entity Type:Organization
Organization Name:ALTERNATIVE COMMUNITY RESOURCE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KAYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEREKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-535-2277
Mailing Address - Street 1:131 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1628
Mailing Address - Country:US
Mailing Address - Phone:814-535-2277
Mailing Address - Fax:
Practice Address - Street 1:3759 BUSINESS RT. 220
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522
Practice Address - Country:US
Practice Address - Phone:814-623-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare