Provider Demographics
NPI:1306003249
Name:LACKAWANNA/SUSQUEHANNA OFFICE OF DRUG AND ALCOHOL PROGRAMS
Entity Type:Organization
Organization Name:LACKAWANNA/SUSQUEHANNA OFFICE OF DRUG AND ALCOHOL PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-963-6820
Mailing Address - Street 1:507 LINDEN STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1633
Mailing Address - Country:US
Mailing Address - Phone:570-963-6820
Mailing Address - Fax:570-963-6617
Practice Address - Street 1:507 LINDEN ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1608
Practice Address - Country:US
Practice Address - Phone:570-963-6743
Practice Address - Fax:570-963-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management