Provider Demographics
NPI:1326478587
Name:OFFICE OF LABOR & INDUSTRY
Entity Type:Organization
Organization Name:OFFICE OF LABOR & INDUSTRY
Other - Org Name:COMW OF PA DEPT OF LABOR&INDUSTRY HIRAM G ANDREWS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF INSTITUTIONAL MANAGEMEN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZAKRAYSEK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:814-254-0442
Mailing Address - Street 1:1407 EISENHOWER BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3262
Mailing Address - Country:US
Mailing Address - Phone:814-269-1494
Mailing Address - Fax:814-266-8572
Practice Address - Street 1:727 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3025
Practice Address - Country:US
Practice Address - Phone:814-254-0442
Practice Address - Fax:814-254-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA5343320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAPPLICATION ON FILEMedicaid
PAAPPLICATION ON FILEMedicaid