Provider Demographics
NPI:1346455649
Name:BRADFORD COUNTY HUMAN SERVICES
Entity Type:Organization
Organization Name:BRADFORD COUNTY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-1760
Mailing Address - Street 1:220 MAIN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1822
Practice Address - Country:US
Practice Address - Phone:570-265-1760
Practice Address - Fax:570-265-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251B00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007780690001OtherTARGETED SERVICES MANAGEM
PA1007780690003OtherEARLY INTERVENTION
PA1007780690006OtherINTENSIVE CASE MANAGEMENT
PA1000072830014OtherRESOURCE COORDINATION
PA1000072830013OtherCYS