Provider Demographics
NPI:1356462105
Name:NORTHEAST COMMUNITY CRISIS UNIT
Entity Type:Organization
Organization Name:NORTHEAST COMMUNITY CRISIS UNIT
Other - Org Name:NORTHEAST COMMUNITY CRISIS UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:KNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-552-3900
Mailing Address - Street 1:126 N. WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634
Mailing Address - Country:US
Mailing Address - Phone:570-735-8195
Mailing Address - Fax:
Practice Address - Street 1:126 N. WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634
Practice Address - Country:US
Practice Address - Phone:570-735-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001443176-0001Medicaid