Provider Demographics
NPI:1407061120
Name:CUMBERLAND-PERRY DRUG AND ALCOHOL COMMISSION
Entity Type:Organization
Organization Name:CUMBERLAND-PERRY DRUG AND ALCOHOL COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-240-6300
Mailing Address - Street 1:16 W HIGH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2919
Mailing Address - Country:US
Mailing Address - Phone:717-240-6300
Mailing Address - Fax:717-240-6488
Practice Address - Street 1:16 W HIGH ST STE 302
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2919
Practice Address - Country:US
Practice Address - Phone:717-240-6300
Practice Address - Fax:717-240-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000073090012Medicaid