Provider Demographics
NPI:1386837409
Name:TRI COUNTY HUMAN SERVICES CENTER INC
Entity Type:Organization
Organization Name:TRI COUNTY HUMAN SERVICES CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLERICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-282-1732
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:185 FALLBROOK ST
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-0514
Mailing Address - Country:US
Mailing Address - Phone:570-282-1732
Mailing Address - Fax:570-282-6808
Practice Address - Street 1:RT 706 E
Practice Address - Street 2:LAKE PLAZA 2
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801
Practice Address - Country:US
Practice Address - Phone:570-282-3393
Practice Address - Fax:570-278-1716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI COUNTY HUMAN SERVICES CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001889Medicaid
PA100001889Medicaid
059746Medicare PIN